Provider Demographics
NPI:1144231234
Name:TAFT, DAVID NICKERSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NICKERSON
Last Name:TAFT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2262
Mailing Address - Country:US
Mailing Address - Phone:207-725-2062
Mailing Address - Fax:207-729-7129
Practice Address - Street 1:53 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2262
Practice Address - Country:US
Practice Address - Phone:207-725-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME24521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice