Provider Demographics
NPI:1063187904
Name:SADHAK, NISHANTH DWAYEKATHVA (DDS)
Entity type:Individual
Prefix:
First Name:NISHANTH
Middle Name:DWAYEKATHVA
Last Name:SADHAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ARBOR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9336
Mailing Address - Country:US
Mailing Address - Phone:518-250-8535
Mailing Address - Fax:
Practice Address - Street 1:14 BISHOP RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NH
Practice Address - Zip Code:03220-3110
Practice Address - Country:US
Practice Address - Phone:603-600-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice