Provider Demographics
NPI:1831557230
Name:NIKOLAUS, CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:NIKOLAUS
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 1:1583 PRESCOTT VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1556
Mailing Address - Country:US
Mailing Address - Phone:480-717-2847
Mailing Address - Fax:
Practice Address - Street 1:1583 PRESCOTT VIEW CIR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1556
Practice Address - Country:US
Practice Address - Phone:480-717-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0009395122300000X
TN11411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist