Provider Demographics
NPI:1003123902
Name:FLANIGAN, NICOLE JEAN (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JEAN
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MAIN ST
Mailing Address - Street 2:#A
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-2187
Mailing Address - Country:US
Mailing Address - Phone:949-874-2860
Mailing Address - Fax:
Practice Address - Street 1:840 MAIN ST
Practice Address - Street 2:#A
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-2187
Practice Address - Country:US
Practice Address - Phone:949-874-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist