Provider Demographics
NPI:1215051529
Name:NILES, DAVID CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:NILES
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 1:1180 S CENTURY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1827
Mailing Address - Country:US
Mailing Address - Phone:608-997-4002
Mailing Address - Fax:608-997-4004
Practice Address - Street 1:1180 S CENTURY AVE STE C
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1827
Practice Address - Country:US
Practice Address - Phone:608-997-4002
Practice Address - Fax:608-997-4004
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190205611223G0001X
WI7163-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice