1215959234 NPI number — DR. NICHOLAS PETER KONDON DMD

Table of content: DR. NICHOLAS PETER KONDON DMD (NPI 1215959234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215959234 NPI number — DR. NICHOLAS PETER KONDON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KONDON
Provider First Name:
NICHOLAS
Provider Middle Name:
PETER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215959234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
290 BAKER AVENUE
Provider Second Line Business Mailing Address:
SUITE S203
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-369-9090
Provider Business Mailing Address Fax Number:
978-371-2936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
290 BAKER AVENUE
Provider Second Line Business Practice Location Address:
SUITE S203
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-369-9090
Provider Business Practice Location Address Fax Number:
978-371-2936
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  17715 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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