Provider Demographics
NPI:1770882953
Name:NAVARRO, NICHOLAS CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHRISTOPHER
Last Name:NAVARRO
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 1:387 E MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8413
Mailing Address - Country:US
Mailing Address - Phone:631-665-3422
Mailing Address - Fax:631-859-1713
Practice Address - Street 1:387 E MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8413
Practice Address - Country:US
Practice Address - Phone:631-665-3422
Practice Address - Fax:631-859-1713
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist