Provider Demographics
NPI:1104219187
Name:DUVAL, NICOLE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:DUVAL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3023
Mailing Address - Country:US
Mailing Address - Phone:603-275-0161
Mailing Address - Fax:
Practice Address - Street 1:1142 SOMERVILLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2847
Practice Address - Country:US
Practice Address - Phone:603-622-9225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-14
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist