Provider Demographics
NPI:1609069897
Name:BRANCA, NICOLE CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:BRANCA
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 1:5716 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7526
Mailing Address - Country:US
Mailing Address - Phone:817-237-1610
Mailing Address - Fax:
Practice Address - Street 1:1050 5TH AVE STE G
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2903
Practice Address - Country:US
Practice Address - Phone:817-332-9700
Practice Address - Fax:817-332-9768
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice