Provider Demographics
NPI:1952417560
Name:NIKNAM, ANGELA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:NIKNAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSITY BLVD
Mailing Address - Street 2:#340
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1001
Mailing Address - Country:US
Mailing Address - Phone:512-904-0672
Mailing Address - Fax:512-904-0699
Practice Address - Street 1:200 UNIVERSITY BLVD
Practice Address - Street 2:#340
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1001
Practice Address - Country:US
Practice Address - Phone:512-904-0672
Practice Address - Fax:512-904-0699
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist