Provider Demographics
NPI:1083368229
Name:NICI, DANIELLE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:ANN
Last Name:NICI
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 1:1325 N WALKER AVE APT 338
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-6402
Mailing Address - Country:US
Mailing Address - Phone:516-333-5935
Mailing Address - Fax:
Practice Address - Street 1:1517 MALL DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3111
Practice Address - Country:US
Practice Address - Phone:319-337-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-099611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADDS-09961OtherIOWA DENTAL BOARD