Provider Demographics
NPI:1366624629
Name:PAMELA A NICOARA DDS MSD PLLC
Entity Type:Organization
Organization Name:PAMELA A NICOARA DDS MSD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ADRIENNE
Authorized Official - Last Name:NICOARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD PLLC
Authorized Official - Phone:425-374-5380
Mailing Address - Street 1:2012 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2212
Mailing Address - Country:US
Mailing Address - Phone:206-218-7352
Mailing Address - Fax:
Practice Address - Street 1:3125 COLBY AVE
Practice Address - Street 2:SUITE H
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4032
Practice Address - Country:US
Practice Address - Phone:425-374-5380
Practice Address - Fax:425-374-5382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA107701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty