Provider Demographics
NPI:1467980169
Name:BECKER, NICOLE BRASIL (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BRASIL
Last Name:BECKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2813
Mailing Address - Country:US
Mailing Address - Phone:203-287-0666
Mailing Address - Fax:
Practice Address - Street 1:1240 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-2813
Practice Address - Country:US
Practice Address - Phone:203-287-0666
Practice Address - Fax:203-288-1851
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice