Provider Demographics
NPI:1689009987
Name:CAULDER, NICOLE (RDH)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CAULDER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3813
Mailing Address - Country:US
Mailing Address - Phone:503-325-6662
Mailing Address - Fax:
Practice Address - Street 1:520 15TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3813
Practice Address - Country:US
Practice Address - Phone:503-325-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5083124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist