Provider Demographics
NPI:1265020952
Name:SAVAGE, NICOLE (RDH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SAVAGE
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 1:265 RED TAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-9441
Mailing Address - Country:US
Mailing Address - Phone:720-400-6869
Mailing Address - Fax:
Practice Address - Street 1:265 RED TAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452-9441
Practice Address - Country:US
Practice Address - Phone:720-400-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002025477124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist