Provider Demographics
NPI:1548902752
Name:NICKEL PEDIATRIC DENTISTRY INC
Entity type:Organization
Organization Name:NICKEL PEDIATRIC DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-500-7547
Mailing Address - Street 1:925 TURTLE COVE LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2323
Mailing Address - Country:US
Mailing Address - Phone:949-500-7447
Mailing Address - Fax:
Practice Address - Street 1:2145 INDIAN RIVER BLVD STE B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5218
Practice Address - Country:US
Practice Address - Phone:772-242-9949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental