Organization
CHARLES A. NICKOU, D.M.D LLC
Active
Other names
Charles A. Nickou, D.M.D
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES A NICKOU D.M.D (DENTIST/OWNER)
(978) 462-9643
Entity
Organization
Contact information
Practice address
16 HARRIS STREET, NEWBURYPORT, MA 01950
(978) 462-9643
(978) 462-6167
Mailing address
16 HARRIS STREET, NEWBURYPORT, MA 01950
(978) 462-9643
(978) 462-6167
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15915
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15915
DENTAL LICENSE
MA
Enumeration date
08/31/2016
Last updated
08/31/2016
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