Provider Demographics
NPI:1679954937
Name:TRAICOFF, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:TRAICOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUEBEC ST
Mailing Address - Street 2:BLDG 500 UNIT 105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7144
Mailing Address - Country:US
Mailing Address - Phone:303-364-6659
Mailing Address - Fax:303-537-1222
Practice Address - Street 1:200 QUEBEC ST
Practice Address - Street 2:BLDG 500 UNIT 105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7144
Practice Address - Country:US
Practice Address - Phone:303-364-6659
Practice Address - Fax:303-537-1222
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILDH 002023635124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist