Provider Demographics
NPI:1750319067
Name:JANE, NICOLE MARIE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:JANE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:33627 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3077
Mailing Address - Country:US
Mailing Address - Phone:248-471-1555
Mailing Address - Fax:248-471-4146
Practice Address - Street 1:33627 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3077
Practice Address - Country:US
Practice Address - Phone:248-471-1555
Practice Address - Fax:248-471-4146
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533201223X0400X
NVS3-1441223X0400X
MI29010175331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics