Provider Demographics
NPI:1003543745
Name:CID, NICHOL MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:NICHOL
Middle Name:MARIE
Last Name:CID
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12682 SW 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3514
Mailing Address - Country:US
Mailing Address - Phone:305-781-0179
Mailing Address - Fax:
Practice Address - Street 1:9560 SW 107TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2790
Practice Address - Country:US
Practice Address - Phone:305-274-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist