Provider Demographics
NPI:1679070163
Name:SEARCEY, NICOLE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:A
Last Name:SEARCEY
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 1:0005 MEDICAL GROUP @ 5MDG/SGQ
Mailing Address - Street 2:194 MISSILE AVENUE
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58705-5024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:0005 MEDICAL GROUP @ 5MDG/SGQ
Practice Address - Street 2:194 MISSILE AVENUE
Practice Address - City:MINOT AFB
Practice Address - State:ND
Practice Address - Zip Code:58705-5024
Practice Address - Country:US
Practice Address - Phone:402-232-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE74691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program