Provider Demographics
NPI:1215959234
Name:KONDON, NICHOLAS PETER (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PETER
Last Name:KONDON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:290 BAKER AVENUE
Mailing Address - Street 2:SUITE S203
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-9090
Mailing Address - Fax:978-371-2936
Practice Address - Street 1:290 BAKER AVENUE
Practice Address - Street 2:SUITE S203
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-9090
Practice Address - Fax:978-371-2936
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics