Provider Demographics
NPI:1588805535
Name:KUSKE, NICOLE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:KUSKE
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 1:18341 PAMMY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1433
Mailing Address - Country:US
Mailing Address - Phone:562-964-0877
Mailing Address - Fax:
Practice Address - Street 1:18341 PAMMY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1433
Practice Address - Country:US
Practice Address - Phone:562-964-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist