Healthcare Provider Details

I. General information

NPI: 1962590380
Provider Name (Legal Business Name): GRACE A. NAKOS, DMD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HEBRON AVE
GLASTONBURY CT
06033
US

IV. Provider business mailing address

141 HEBRON AVE
GLASTONBURY CT
06033
US

V. Phone/Fax

Practice location:
  • Phone: 860-633-5467
  • Fax: 860-652-9318
Mailing address:
  • Phone: 860-633-5467
  • Fax: 860-652-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7620
License Number StateCT

VIII. Authorized Official

Name: DR. GRACE A NAKOS
Title or Position: PRESIDENT
Credential: DMD
Phone: 860-633-5467