Provider Demographics
NPI:1962781898
Name:NAVARRO, NICHOLAS PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PATRICK
Last Name:NAVARRO
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 1:619 8TH ST SE UNIT 215
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1192
Mailing Address - Country:US
Mailing Address - Phone:507-838-6985
Mailing Address - Fax:
Practice Address - Street 1:14600 GRANADA DR
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7419
Practice Address - Country:US
Practice Address - Phone:952-432-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12980122300000X
MND12980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist