Provider Demographics
NPI:1174196471
Name:NAUMOWICZ, NIKITA ANNA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIKITA
Middle Name:ANNA
Last Name:NAUMOWICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1702
Mailing Address - Country:US
Mailing Address - Phone:207-216-2156
Mailing Address - Fax:
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4027
Practice Address - Country:US
Practice Address - Phone:508-587-7775
Practice Address - Fax:508-256-2452
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist