Provider Demographics
NPI:1215672423
Name:NATH, ANKAA
Entity type:Individual
Prefix:
First Name:ANKAA
Middle Name:
Last Name:NATH
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 1:705 13TH AVE N APT 215
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2681
Mailing Address - Country:US
Mailing Address - Phone:909-780-9980
Mailing Address - Fax:
Practice Address - Street 1:1650 45TH ST S STE 108
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3247
Practice Address - Country:US
Practice Address - Phone:701-526-4652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist