Provider Demographics
NPI:1174730527
Name:NISTA, JOSEPH TYRONE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TYRONE
Last Name:NISTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 NEW RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-9605
Mailing Address - Country:US
Mailing Address - Phone:518-479-0993
Mailing Address - Fax:518-435-0487
Practice Address - Street 1:1035 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1225
Practice Address - Country:US
Practice Address - Phone:518-435-0462
Practice Address - Fax:518-435-0487
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0401841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice