Individual
DR. CHARLES A NICKOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
16 HARRIS ST, NEWBURYPORT, MA 01950-2603
(978) 462-9643
(978) 462-6167
Mailing address
25 BOSTON RD, NEWBURY, MA 01951-1602
(978) 465-1878
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15915
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X08063
BLUE CROSS BLUE SHIELD ID
MA
Enumeration date
04/24/2007
Last updated
07/08/2007
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