Provider Demographics
NPI:1598921660
Name:TEIFER, NICOLE DANIELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DANIELLE
Last Name:TEIFER
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 1:44633 JOY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1730
Mailing Address - Country:US
Mailing Address - Phone:734-454-9200
Mailing Address - Fax:
Practice Address - Street 1:44633 JOY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1730
Practice Address - Country:US
Practice Address - Phone:734-454-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75941223X0400X
CA578891223X0400X
MI29010201301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics