Provider Demographics
NPI:1659450757
Name:BOAZ, NICHOLE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:E
Last Name:BOAZ
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 1:5805 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3546
Mailing Address - Country:US
Mailing Address - Phone:423-894-9950
Mailing Address - Fax:423-894-1916
Practice Address - Street 1:5805 LEE HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3546
Practice Address - Country:US
Practice Address - Phone:423-894-9950
Practice Address - Fax:423-894-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000053331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice