Provider Demographics
NPI:1417218215
Name:MINNAH, NITHYA (DMD, MMSC)
Entity type:Individual
Prefix:DR
First Name:NITHYA
Middle Name:
Last Name:MINNAH
Suffix:
Gender:F
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NEWBURY ST STE 501
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2971
Mailing Address - Country:US
Mailing Address - Phone:617-472-3919
Mailing Address - Fax:
Practice Address - Street 1:115 NEWBURY ST STE 501
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2971
Practice Address - Country:US
Practice Address - Phone:617-536-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855975122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist