Provider Demographics
NPI:1841638962
Name:NANDA, NANDITA (DMD)
Entity type:Individual
Prefix:DR
First Name:NANDITA
Middle Name:
Last Name:NANDA
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 1:206 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4017
Mailing Address - Country:US
Mailing Address - Phone:405-707-6135
Mailing Address - Fax:405-707-0602
Practice Address - Street 1:1201 S JACKSON RD
Practice Address - Street 2:UNIT 12
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6859
Practice Address - Country:US
Practice Address - Phone:956-683-0386
Practice Address - Fax:956-683-0506
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist