Provider Demographics
NPI:1679913222
Name:MASKAS, NICKOLAS STANLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:STANLEY
Last Name:MASKAS
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 1:4720 LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-888-4771
Mailing Address - Fax:337-888-4772
Practice Address - Street 1:4720 LAKE STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-888-4771
Practice Address - Fax:337-888-4772
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11901223S0112X
LA63651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery