Provider Demographics
NPI:1376190959
Name:BISHOP, NICOLE FELICE (RDH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:FELICE
Last Name:BISHOP
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 1:4045 IRONWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-4136
Mailing Address - Country:US
Mailing Address - Phone:302-363-2512
Mailing Address - Fax:
Practice Address - Street 1:BLDG#678 MCCORNACK ROAD
Practice Address - Street 2:NA KOA DENTAL CLINIC
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-433-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9270194-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist