Provider Demographics
NPI:1982255436
Name:NAYAK, ROJALINA
Entity Type:Individual
Prefix:
First Name:ROJALINA
Middle Name:
Last Name:NAYAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 OCONNOR DR APT 3812
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5589
Mailing Address - Country:US
Mailing Address - Phone:914-612-3595
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 4250 CLEAR CREEK ROAD
Practice Address - Street 2:STE #213
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-284-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0423131223G0001X
TX355831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice