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General NPI Number Information
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NPI Number | 1669698411
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Entity Type | Individual
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Provider Name | NICHOLAS JOHN TOTALO JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 ELIZABETH ST
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City | DERBY
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State | CT
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Zip | 06418-1835
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Country | US
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Telephone | 203-735-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 RACEBROOK RD
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City | WOODBRIDGE
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State | CT
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Zip | 06525-1836
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Country | US
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Telephone | 203-397-1605
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3776
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License Number State | CT
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