Individual
DR. DENNIS CRANDALL NICOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2730 SW MOODY AVE, PORTLAND, OR 97201-5042
(503) 346-4725
Mailing address
8485 SW CONNEMARA PL, BEAVERTON, OR 97008-6934
(503) 641-3612
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D5433
OR
Other
Enumeration date
07/05/2005
Last updated
07/25/2014
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