Provider Demographics
NPI:1467119545
Name:NUCKOLLS, NATALIE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:ANN
Last Name:NUCKOLLS
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 1:700 MCHUGH BVLD
Mailing Address - Street 2:HP 102
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0125
Mailing Address - Country:US
Mailing Address - Phone:910-451-1658
Mailing Address - Fax:
Practice Address - Street 1:700 MCHUGH BVLD
Practice Address - Street 2:HP 102
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0125
Practice Address - Country:US
Practice Address - Phone:910-451-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist