Provider Demographics
NPI:1316051543
Name:NILES, DAVID GEORGE (DDS MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:NILES
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2555 CAL YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6441
Mailing Address - Country:US
Mailing Address - Phone:541-484-1943
Mailing Address - Fax:541-485-2496
Practice Address - Street 1:2555 CAL YOUNG RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6441
Practice Address - Country:US
Practice Address - Phone:541-484-1943
Practice Address - Fax:541-485-2496
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD73261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics