Individual
DR. NIEKU MANSHADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8716 RESEARCH BLVD, SUITE 125, AUSTIN, TX 78758-6420
(512) 454-4646
Mailing address
8716 RESEARCH BLVD, SUITE 125, AUSTIN, TX 78758-6420
(512) 454-4646
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
059560
NY
1223P0221X
Pediatric Dentistry
Primary
24870
TX
1223P0221X
Pediatric Dentistry
56477
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05154687
—
NY
05
—
204782102
—
TX
Enumeration date
08/12/2008
Last updated
12/05/2018
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