Provider Demographics
NPI:1720335748
Name:CIVIDANES, NICOLE ARIANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ARIANA
Last Name:CIVIDANES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 86TH ST
Mailing Address - Street 2:APT 15F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6403
Mailing Address - Country:US
Mailing Address - Phone:646-683-0202
Mailing Address - Fax:
Practice Address - Street 1:182 WILSON ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2028
Practice Address - Country:US
Practice Address - Phone:207-989-1952
Practice Address - Fax:207-989-1956
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0561901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice