Provider Demographics
NPI:1306239207
Name:NIKITAS, MYRA JEAN (RDH)
Entity type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:JEAN
Last Name:NIKITAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:MYRA
Other - Middle Name:JEAN
Other - Last Name:KATIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:97 WEST MERRIMACK STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-669-8678
Mailing Address - Fax:603-625-8373
Practice Address - Street 1:97 WEST MERRIMACK STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-669-8678
Practice Address - Fax:603-625-8373
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02520124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist