Provider Demographics
NPI:1548287105
Name:NITU, VICTOR L (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:NITU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8663 W UNION HILLS DR
Mailing Address - Street 2:SUITE #400
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-7004
Mailing Address - Country:US
Mailing Address - Phone:623-933-8500
Mailing Address - Fax:623-933-8501
Practice Address - Street 1:8663 W UNION HILLS DR
Practice Address - Street 2:SUITE #400
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7004
Practice Address - Country:US
Practice Address - Phone:623-933-8500
Practice Address - Fax:623-933-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice