Provider Demographics
NPI:1417356684
Name:THIELER, NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:THIELER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:THIELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 MYSTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2762
Mailing Address - Country:US
Mailing Address - Phone:985-876-4484
Mailing Address - Fax:985-876-4498
Practice Address - Street 1:206 MYSTIC BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2762
Practice Address - Country:US
Practice Address - Phone:985-876-4484
Practice Address - Fax:985-876-4498
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics