Healthcare Provider Details

I. General information

NPI: 1164491411
Provider Name (Legal Business Name): NICHOLAS A VERO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 CEDAR LN
TEANECK NJ
07666-1705
US

IV. Provider business mailing address

756 CEDAR LN
TEANECK NJ
07666-1705
US

V. Phone/Fax

Practice location:
  • Phone: 201-692-1919
  • Fax: 201-692-0704
Mailing address:
  • Phone: 201-692-1919
  • Fax: 201-692-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD109382
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: