Provider Demographics
NPI:1376737866
Name:BOXBERGER, NICOLE RENEE' (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:RENEE'
Last Name:BOXBERGER
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 1:4061 BEHRMAN HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114
Mailing Address - Country:US
Mailing Address - Phone:504-368-1990
Mailing Address - Fax:504-366-2319
Practice Address - Street 1:4061 BEHRMAN HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114
Practice Address - Country:US
Practice Address - Phone:504-368-1990
Practice Address - Fax:504-366-2319
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5908122300000X, 1223P0221X
MO2007014391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1859087Medicaid