Organization
NIVA DENTAL SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHOUVIK PONNUSAMY DMD (OWNER)
(630) 267-1199
Entity
Organization
Contact information
Practice address
15141 RONALD REAGAN BLVD, SUITE 516, LEANDER, TX 78641-7864
(512) 881-8852
(512) 881-7721
Mailing address
1511 RIMSTONE DR, CEDAR PARK, TX 78613-7692
(630) 267-1199
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/06/2022
Last updated
12/06/2022
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