Organization
GENERAL DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LEON NICOLA DDS (OWNER)
(269) 327-6765
Entity
Organization
Contact information
Practice address
1522 W CENTRE AVENUE, PORTAGE, MI 49024
(269) 327-6765
(269) 327-1138
Mailing address
1522 W CENTRE AVENUE, PORTAGE, MI 49024
(269) 327-6765
(269) 327-1138
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/21/2007
Last updated
08/22/2020
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