Provider Demographics
NPI:1831312529
Name:ADDIEGO, NICHOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:ADDIEGO
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 1:810 BARNEGAT AVE STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHIP BOTTOM
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-4686
Mailing Address - Country:US
Mailing Address - Phone:609-361-2900
Mailing Address - Fax:609-361-2902
Practice Address - Street 1:810 BARNEGAT AVE STE A
Practice Address - Street 2:SUITE A
Practice Address - City:SHIP BOTTOM
Practice Address - State:NJ
Practice Address - Zip Code:08008-4686
Practice Address - Country:US
Practice Address - Phone:609-361-2900
Practice Address - Fax:609-361-2902
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 0203341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics