Provider Demographics
NPI:1457458978
Name:NICHOLAS G. KALEEL DMD PA
Entity Type:Organization
Organization Name:NICHOLAS G. KALEEL DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KALEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-736-9997
Mailing Address - Street 1:555 N CONGRESS AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3469
Mailing Address - Country:US
Mailing Address - Phone:561-736-9997
Mailing Address - Fax:561-736-3800
Practice Address - Street 1:555 N CONGRESS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3469
Practice Address - Country:US
Practice Address - Phone:561-736-9997
Practice Address - Fax:561-736-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9870261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL530204OtherUNITED CONCORDIA
FL53149-1OtherUNITED HEALTHCARE
FL77499OtherBLUE CROSS/BLUE SHIELD
FL77499OtherBLUE CROSS/BLUE SHIELD