Nisha Maniar Kancherla, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN015970 Issued in GA

Practice address

320 Killian Hill Rd NW
Lilburn, GA 30047-3809

Phone

(770) 921-3555

NPI assigned

Nov 7, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Nisha Bharat Maniar Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• M Forest Butler DDS Ms PC

  • Periodontics
  • Lilburn, GA
  • NPI 1679977656
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1699104927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3644 VIA NUOVA LN",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300245044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 KILLIAN HILL RD NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473809",
            "telephone_number": "770-921-3555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2406 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Colmar",
            "state": "PA",
            "postal_code": "189159701",
            "country_code": "US",
            "telephone_number": "216-224-1780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANCHERLA",
        "first_name": "NISHA",
        "middle_name": "MANIAR",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS039792",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "DN015970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NISHA",
            "last_name": "MANIAR",
            "middle_name": "BHARAT",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Periodontics in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.