Provider Demographics
NPI:1730468174
Name:WENDELL, NICOLE FRIA (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:FRIA
Last Name:WENDELL
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17016 PALACIO PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1456
Mailing Address - Country:US
Mailing Address - Phone:858-945-8954
Mailing Address - Fax:
Practice Address - Street 1:17016 PALACIO PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1456
Practice Address - Country:US
Practice Address - Phone:858-945-8954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364124Q00000X
CA16858124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist