Provider Demographics
NPI:1124320585
Name:ROWLEY, NICHOLAS BRAD (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BRAD
Last Name:ROWLEY
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 1:205 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4300
Mailing Address - Country:US
Mailing Address - Phone:321-723-1772
Mailing Address - Fax:321-723-2886
Practice Address - Street 1:205 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4300
Practice Address - Country:US
Practice Address - Phone:321-723-1772
Practice Address - Fax:321-723-2886
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 191241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice