Provider Demographics
NPI:1740842954
Name:KITCOFF, NICHOLAS (DDS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KITCOFF
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 1:2978 WEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4090
Mailing Address - Country:US
Mailing Address - Phone:317-918-7692
Mailing Address - Fax:
Practice Address - Street 1:17567 RIVER RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8528
Practice Address - Country:US
Practice Address - Phone:317-773-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013230A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice