Provider Demographics
NPI:1013585025
Name:CODER, NIECOLE MONISHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIECOLE
Middle Name:MONISHA
Last Name:CODER
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 1:161 SUMMERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-8615
Mailing Address - Country:US
Mailing Address - Phone:206-660-1438
Mailing Address - Fax:
Practice Address - Street 1:1617 183RD ST SE UNIT 2
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6812
Practice Address - Country:US
Practice Address - Phone:425-368-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61155879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist