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Individual

NIDHI TANEJA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
5757 PACIFIC AVE STE A-145, STOCKTON, CA 95207-5100
(310) 694-4419
Mailing address
3401 OAKDALE RD # 505, MODESTO, CA 95355
(209) 287-5940

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
059687
NY
1223P0221X
Pediatric Dentistry
Primary
104339
CA
1223P0221X
Pediatric Dentistry
12163
CT
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
07/25/2014
Last updated
02/08/2021
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