Provider Demographics
NPI:1316344427
Name:MITTAL, NITIKA (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:NITIKA
Middle Name:
Last Name:MITTAL
Suffix:
Gender:F
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BELLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4646
Mailing Address - Country:US
Mailing Address - Phone:540-659-8302
Mailing Address - Fax:
Practice Address - Street 1:101 BELLINGHAM DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4646
Practice Address - Country:US
Practice Address - Phone:540-659-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014135261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics