Provider Demographics
NPI:1710298799
Name:COMERFORD, NICHOLAS PARKER (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PARKER
Last Name:COMERFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 ATLANTIC BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1137
Mailing Address - Country:US
Mailing Address - Phone:904-374-3787
Mailing Address - Fax:904-619-6571
Practice Address - Street 1:4521 ATLANTIC BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1137
Practice Address - Country:US
Practice Address - Phone:904-374-3787
Practice Address - Fax:904-629-6571
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN190701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice