Individual provider Active NPI

Shikha Nandal, DDS

  • Dentist
  • Hinesville, GA
National Provider Identifier
1891364170
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN122357 Issued in GA
Practice address
303 Fraser Dr
Hinesville, GA 31313-3712
Phone
(912) 877-2227
Fax
(912) 877-2332
NPI assigned
Jun 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN122357 GA Primary

Addresses

Primary practice location

303 Fraser Dr
Hinesville, GA 31313-3712

Mailing address

1650 N Roberts Rd NW
Kennesaw, GA 30144-3634
Phone (702) 234-7484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221017000052 GA Practitioner - Dentist 5597131565 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN122357GAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Diversity Health Center Inc CurrentSince Oct 7, 2022 Accepting new patients
Diversity Health Center Inc. CurrentSince Oct 7, 2022 Accepting new patients
Diversity Health Center Inc. Current Accepting new patients

Locations

303 Fraser Dr
Hinesville, GA 31313
Phone (912) 255-5523

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1891364170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 N ROBERTS RD NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301443634",
            "telephone_number": "702-234-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 FRASER DR",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133712",
            "telephone_number": "912-877-2227",
            "fax_number": "912-877-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANDAL",
        "first_name": "SHIKHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN122357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hinesville, GA

Sources for this page

Verify at the official NPI Registry.