Provider Demographics
NPI:1790090769
Name:NICOLE DAHLKEMPER, DMD, PC
Entity Type:Organization
Organization Name:NICOLE DAHLKEMPER, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAHLKEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-884-6166
Mailing Address - Street 1:1203 TWO ISLAND CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7405
Mailing Address - Country:US
Mailing Address - Phone:843-884-6166
Mailing Address - Fax:843-884-1140
Practice Address - Street 1:1203 TWO ISLAND CT
Practice Address - Street 2:SUITE 101
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7405
Practice Address - Country:US
Practice Address - Phone:843-884-6166
Practice Address - Fax:843-884-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty