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General NPI Number Information
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NPI Number | 1962590380
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Entity Type | Organization
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Legal Business Name | GRACE A. NAKOS, DMD, P.C.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 141 HEBRON AVE
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 860-633-5467
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Fax | 860-652-9318
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Provider Business Mailing Address
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Address Line | 141 HEBRON AVE
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City | GLASTONBURY
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State | CT
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Zip | 06033
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Country | US
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Telephone | 860-633-5467
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Fax | 860-652-9318
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GRACE A NAKOS
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Credential | DMD
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Telephone | 860-633-5467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7620
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License Number State | CT
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