Provider Demographics
NPI:1497929244
Name:NICASTRO, NICHOLAS JOHN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:NICASTRO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5225 ROUTE 347
Mailing Address - Street 2:SUITE 52
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2053
Mailing Address - Country:US
Mailing Address - Phone:631-928-2020
Mailing Address - Fax:631-928-2417
Practice Address - Street 1:5225 ROUTE 347
Practice Address - Street 2:SUITE 52
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2053
Practice Address - Country:US
Practice Address - Phone:631-928-2020
Practice Address - Fax:631-928-2417
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0484671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice