Individual
NICKALUS STEVENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1581 MAIN ST, WILLIMANTIC, CT 06226-1134
(860) 456-3214
Mailing address
1581 MAIN ST, WILLIMANTIC, CT 06226-1134
(860) 456-3214
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13192
CT
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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