Provider Demographics
NPI:1659563245
Name:WOLFGRAMM, NICOLE ROBISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ROBISON
Last Name:WOLFGRAMM
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 1:250 GAGE BLVD APT 2076
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9685
Mailing Address - Country:US
Mailing Address - Phone:509-737-7153
Mailing Address - Fax:
Practice Address - Street 1:5204 N ROAD 68 STE B
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9275
Practice Address - Country:US
Practice Address - Phone:509-547-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist