Provider Demographics
NPI:1578501995
Name:NAHERNAK, NICHOLAS EMIL (DDS PC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EMIL
Last Name:NAHERNAK
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1204
Mailing Address - Country:US
Mailing Address - Phone:989-872-2181
Mailing Address - Fax:989-872-4471
Practice Address - Street 1:6506 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1204
Practice Address - Country:US
Practice Address - Phone:989-872-2181
Practice Address - Fax:989-872-4471
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist