Provider Demographics
NPI:1033274071
Name:NICOLE L. CHRISTY DDS PC
Entity Type:Organization
Organization Name:NICOLE L. CHRISTY DDS PC
Other - Org Name:BOURBON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-342-4385
Mailing Address - Street 1:909 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOURBON
Mailing Address - State:IN
Mailing Address - Zip Code:46504-1447
Mailing Address - Country:US
Mailing Address - Phone:574-342-4385
Mailing Address - Fax:574-342-0461
Practice Address - Street 1:909 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:IN
Practice Address - Zip Code:46504-1447
Practice Address - Country:US
Practice Address - Phone:574-342-4385
Practice Address - Fax:574-342-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty