Provider Demographics
NPI:1518019645
Name:VANE, NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:VANE
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 1:345 S COAST HIGHWAY 101 STE E
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3552
Mailing Address - Country:US
Mailing Address - Phone:760-632-0320
Mailing Address - Fax:760-632-0380
Practice Address - Street 1:345 S COAST HIGHWAY 101 STE E
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3552
Practice Address - Country:US
Practice Address - Phone:760-632-0320
Practice Address - Fax:760-632-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist