# NIVA DENTAL SPECIALISTS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194436634
- **Authorized official:** DR. SHOUVIK PONNUSAMY DMD (OWNER)
- **Authorized official phone:** (630) 267-1199

## Contact information

- **Practice address:** 15141 RONALD REAGAN BLVD, SUITE 516, LEANDER, TX 78641-7864
- **Practice address phone:** (512) 881-8852
- **Practice address fax:** (512) 881-7721
- **Mailing address:** 1511 RIMSTONE DR, CEDAR PARK, TX 78613-7692
- **Mailing address phone:** (630) 267-1199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2022
- **Last updated:** 12/06/2022