Individual
DR. SHIVALI NAYAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3221 EASTBROOK DR STE A-103, FORT COLLINS, CO 80525-5705
(970) 484-4102
Mailing address
3221 EASTBROOK DR STE A-103, FORT COLLINS, CO 80525-5705
(720) 903-0558
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DEN-10371
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DEN.00010371
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86855867
—
CO
01
—
DEN.00010371
CO DENTAL LICENSE
CO
Enumeration date
03/16/2011
Last updated
05/15/2024
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