| Niva Dental Specialists PLLC | |
|
15141 Ronald Reagan Blvd Suite 516 Leander TX 78641-7864 | |
| (512) 881-8852 | |
| (512) 881-7721 |
| Full Name | Niva Dental Specialists PLLC |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 15141 Ronald Reagan Blvd, Leander, Texas |
| Authorized Official Name and Position | Shouvik Ponnusamy (OWNER) |
| Authorized Official Contact | 6302671199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Niva Dental Specialists PLLC 1511 Rimstone Dr Cedar Park TX 78613-7692 Ph: (630) 267-1199 | Niva Dental Specialists PLLC 15141 Ronald Reagan Blvd Suite 516 Leander TX 78641-7864 Ph: (512) 881-8852 |
| NPI Number | 1194436634 |
|---|---|
| Provider Enumeration Date | 12/06/2022 |
| Last Update Date | 12/06/2022 |
| Certification Date | 12/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194436634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | () | Secondary |
| 1223P0300X | Dentist - Periodontics | () | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | () | Primary |
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