Provider Demographics
NPI:1720255391
Name:MENICOU, NIKOS M (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIKOS
Middle Name:M
Last Name:MENICOU
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 1:1109 KENNEDY PL STE 4
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1271
Mailing Address - Country:US
Mailing Address - Phone:530-753-9900
Mailing Address - Fax:530-753-9930
Practice Address - Street 1:1109 KENNEDY PL STE 4
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1271
Practice Address - Country:US
Practice Address - Phone:530-753-9900
Practice Address - Fax:530-753-9930
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice