Provider Demographics
NPI:1770605826
Name:TRIA, NICHOLAS J (DMD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:J
Last Name:TRIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2975
Mailing Address - Country:US
Mailing Address - Phone:973-696-5444
Mailing Address - Fax:
Practice Address - Street 1:1008 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2975
Practice Address - Country:US
Practice Address - Phone:973-696-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist