Provider Demographics
NPI:1710998752
Name:NIETO, NICOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:NIETO
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 1:701 ENTERPRISE RD. EAST
Mailing Address - Street 2:STE #201
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5303
Mailing Address - Country:US
Mailing Address - Phone:727-799-2400
Mailing Address - Fax:
Practice Address - Street 1:701 ENTERPRISE RD E
Practice Address - Street 2:STE #201
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-5350
Practice Address - Country:US
Practice Address - Phone:727-799-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice