Provider Demographics
NPI:1306008040
Name:SWEET, NICOLE LINA (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LINA
Last Name:SWEET
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 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:503-952-2137
Mailing Address - Fax:
Practice Address - Street 1:2703 DELTA OAKS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1700
Practice Address - Country:US
Practice Address - Phone:541-342-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011192A1223G0001X
ORD102321223G0001X
WADE605600161223G0001X
IL019.0289031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice