NIKA LUSTGARTEN DDS NPI 1487005187

NPI Information

NPI: 1487005187
Provider Name: NIKA LUSTGARTEN, DDS
Classification: Student in an Organized Health Care Education/Training Program - 390200000X
Entity Type: Individual

PECOS Registration: Yes

Address:
3181 SW SAM JACKSON PARK RD
PORTLAND, OR
ZIP 97239
Phone: (503) 494-8211
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Nika Lustgarten, DDS is a student in an organized health care education training program in Portland, OR. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Nika Lustgarten, DDS NPI is 1487005187. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3181 SW SAM JACKSON PARK RD
PORTLAND, OR
ZIP 97239-011
Phone: (503) 494-8211

The NPI 1487005187 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/24/2016 and was last updated on 5/17/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	122300000X	Dentist		1001515-15	WISCONSIN	No
2	390200000X	Student in an Organized Health Care Education/Training Program		D11224	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0076372	MEDICAID	IOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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