Provider Demographics
NPI:1386694693
Name:NATH, AVANTIKA (BDS)
Entity type:Individual
Prefix:DR
First Name:AVANTIKA
Middle Name:
Last Name:NATH
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:DR
Other - First Name:SARITA
Other - Middle Name:
Other - Last Name:RAWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:1380 HOWARD ST
Mailing Address - Street 2:ROOM 508
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3516
Mailing Address - Fax:
Practice Address - Street 1:1380 HOWARD ST
Practice Address - Street 2:ROOM 508
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2638
Practice Address - Country:US
Practice Address - Phone:415-255-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice