Provider Demographics
NPI:1083769079
Name:BADALAMENTI-KALAS, NICKALENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICKALENE
Middle Name:
Last Name:BADALAMENTI-KALAS
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 1:3324 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2757
Mailing Address - Country:US
Mailing Address - Phone:248-340-1118
Mailing Address - Fax:
Practice Address - Street 1:28050 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1562
Practice Address - Country:US
Practice Address - Phone:586-774-6655
Practice Address - Fax:586-774-6928
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0154301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice