Provider Demographics
NPI:1346626777
Name:NAYAK, NISHA PERAMPALLI (DMD)
Entity type:Individual
Prefix:DR
First Name:NISHA
Middle Name:PERAMPALLI
Last Name:NAYAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 STONERIDGE DR
Mailing Address - Street 2:APT 4
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8242
Mailing Address - Country:US
Mailing Address - Phone:201-906-2095
Mailing Address - Fax:
Practice Address - Street 1:3906 STONERIDGE DR
Practice Address - Street 2:APT 4
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8242
Practice Address - Country:US
Practice Address - Phone:201-906-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice