Provider Demographics
NPI:1225231681
Name:PRICE, NICOLE STROUD (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:STROUD
Last Name:PRICE
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 1:110 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3417
Mailing Address - Country:US
Mailing Address - Phone:843-774-8788
Mailing Address - Fax:843-774-1755
Practice Address - Street 1:203 S MARION ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1522
Practice Address - Country:US
Practice Address - Phone:843-752-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4320Medicaid