Provider Demographics
NPI:1134499304
Name:NAKOS, GRACE A
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:NAKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4200
Mailing Address - Country:US
Mailing Address - Phone:860-633-5467
Mailing Address - Fax:860-652-9318
Practice Address - Street 1:141 HEBRON AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4200
Practice Address - Country:US
Practice Address - Phone:860-633-5467
Practice Address - Fax:860-652-9318
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist