Provider Demographics
NPI:1457893745
Name:C. NICHOLAS DETURE PA
Entity Type:Organization
Organization Name:C. NICHOLAS DETURE PA
Other - Org Name:STUART PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DETURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-283-1400
Mailing Address - Street 1:901 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2429
Mailing Address - Country:US
Mailing Address - Phone:772-283-1400
Mailing Address - Fax:772-283-1488
Practice Address - Street 1:901 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2429
Practice Address - Country:US
Practice Address - Phone:772-283-1400
Practice Address - Fax:772-283-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty