Provider Demographics
NPI:1164860755
Name:NETZEL, NICHOLAS STEPHEN (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:STEPHEN
Last Name:NETZEL
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 1:10750 W MCDOWELL RD STE A250
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5979
Mailing Address - Country:US
Mailing Address - Phone:623-907-9400
Mailing Address - Fax:623-907-9405
Practice Address - Street 1:10750 W MCDOWELL RD STE A250
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5979
Practice Address - Country:US
Practice Address - Phone:623-907-9400
Practice Address - Fax:623-907-9405
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87251223E0200X
AZD008725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics