Provider Demographics
NPI:1871565218
Name:CASAVERDE, NINA B (DMD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:B
Last Name:CASAVERDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:BARDWAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6709
Mailing Address - Country:US
Mailing Address - Phone:603-624-3900
Mailing Address - Fax:603-624-0030
Practice Address - Street 1:72 S RIVER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6709
Practice Address - Country:US
Practice Address - Phone:603-624-3900
Practice Address - Fax:603-624-0030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH34771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007756Medicaid