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General NPI Number Information
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NPI Number | 1427168756
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Entity Type | Individual
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Provider Name | NIKOLAOS GEORGIOS GAVRILIS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 319 PALM CT
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City | INDIALANTIC
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State | FL
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Zip | 32903-4320
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Country | US
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Telephone | 412-901-1781
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Fax |
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Provider Business Mailing Address
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Address Line | 319 PALM CT
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City | INDIALANTIC
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State | FL
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Zip | 32903-4320
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Country | US
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Telephone | 412-901-1781
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 22DI 023174
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22DI 023174
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN28880
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License Number State | FL
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