Provider Demographics
NPI:1902044332
Name:NICOLAIEVSKY, EDUARDO (DDS)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:NICOLAIEVSKY
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 1:4308 ALTON RD
Mailing Address - Street 2:SUITE #850
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-538-4556
Mailing Address - Fax:305-538-2019
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE #850
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-538-4556
Practice Address - Fax:305-538-2019
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 178821223S0112X
TX210181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery