Individual
NIKA LUSTGARTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1001515-15
WI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
D11224
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076372
—
IA
Enumeration date
06/24/2016
Last updated
05/17/2023
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