Provider Demographics
NPI:1831690403
Name:SHIVAM NAND DMD INC
Entity type:Organization
Organization Name:SHIVAM NAND DMD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-333-1875
Mailing Address - Street 1:6855 FAIR OAKS BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3365
Mailing Address - Country:US
Mailing Address - Phone:916-333-1875
Mailing Address - Fax:916-515-8663
Practice Address - Street 1:6855 FAIR OAKS BLVD STE 800
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3365
Practice Address - Country:US
Practice Address - Phone:916-333-1875
Practice Address - Fax:916-515-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty