Provider Demographics
NPI:1174740740
Name:SHIVARAM, NIVEDITA (DDS)
Entity type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:
Last Name:SHIVARAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 MILL BROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3650
Mailing Address - Country:US
Mailing Address - Phone:817-656-4046
Mailing Address - Fax:817-656-4525
Practice Address - Street 1:201, N.EAST ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011
Practice Address - Country:US
Practice Address - Phone:817-277-1165
Practice Address - Fax:817-277-1106
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice