Provider Demographics
NPI:1164719753
Name:NICHELINI, KIMBERLY GRACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:GRACE
Last Name:NICHELINI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-2108
Mailing Address - Country:US
Mailing Address - Phone:707-968-5144
Mailing Address - Fax:
Practice Address - Street 1:176 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2108
Practice Address - Country:US
Practice Address - Phone:707-968-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA634101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty