Provider Demographics
NPI:1811197171
Name:RICHARDSON, NICOLE MARLENE (DDS)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:MARLENE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SHOAL CRK
Mailing Address - Street 2:SUITE 276
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3323
Mailing Address - Country:US
Mailing Address - Phone:972-317-1406
Mailing Address - Fax:888-519-7081
Practice Address - Street 1:1401 SHOAL CRK
Practice Address - Street 2:SUITE 276
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3323
Practice Address - Country:US
Practice Address - Phone:972-317-1406
Practice Address - Fax:888-519-7081
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice