Healthcare Provider Details

I. General information

NPI: 1003543745
Provider Name (Legal Business Name): NICHOL MARIE CID DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9560 SW 107TH AVE STE 206
MIAMI FL
33176-2790
US

IV. Provider business mailing address

12682 SW 78TH ST
MIAMI FL
33183-3514
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-2110
  • Fax:
Mailing address:
  • Phone: 305-781-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: