Provider Demographics
NPI:1407019557
Name:MARQUIS, NICOLE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BOSTON POST RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2155
Mailing Address - Country:US
Mailing Address - Phone:203-318-8327
Mailing Address - Fax:203-318-8327
Practice Address - Street 1:51 BOSTON POST RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2155
Practice Address - Country:US
Practice Address - Phone:203-318-8327
Practice Address - Fax:203-318-8327
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0085091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics