Provider Demographics
NPI:1285737072
Name:NIKAIN, SHIVA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:NIKAIN
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 1:501 DUNWOODY CHACE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6007
Mailing Address - Country:US
Mailing Address - Phone:678-836-2102
Mailing Address - Fax:770-441-0299
Practice Address - Street 1:770 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1618
Practice Address - Country:US
Practice Address - Phone:678-836-2102
Practice Address - Fax:770-441-0299
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN013352OtherDENTIST