Provider Demographics
NPI:1760553564
Name:NICOLAS, NADINE BISHARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:BISHARA
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5973 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4542
Mailing Address - Country:US
Mailing Address - Phone:954-340-4044
Mailing Address - Fax:954-345-3464
Practice Address - Street 1:5973 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4542
Practice Address - Country:US
Practice Address - Phone:954-340-4044
Practice Address - Fax:954-345-3464
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00142921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice