Provider Demographics
NPI:1548568280
Name:RICHARDS, NICOLE ALANA (DMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALANA
Last Name:RICHARDS
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 1:1617 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2303
Mailing Address - Country:US
Mailing Address - Phone:856-857-0033
Mailing Address - Fax:
Practice Address - Street 1:1617 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2303
Practice Address - Country:US
Practice Address - Phone:856-857-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02493500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist