Provider Demographics
NPI:1457456832
Name:NICOLL, ROBERT T (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:NICOLL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HAMPTON ROAD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4808
Mailing Address - Country:US
Mailing Address - Phone:603-778-9630
Mailing Address - Fax:603-778-8466
Practice Address - Street 1:14 HAMPTON ROAD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4808
Practice Address - Country:US
Practice Address - Phone:603-778-9630
Practice Address - Fax:603-778-8466
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH10941223G0001X
NHNH31211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0300XDental ProvidersDentistPeriodontics