Provider Demographics
NPI:1821386780
Name:FRISCH, NIKKI LEE (RDH)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEE
Last Name:FRISCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:LEE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:964 COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:WI
Mailing Address - Zip Code:53559-9735
Mailing Address - Country:US
Mailing Address - Phone:608-988-6472
Mailing Address - Fax:
Practice Address - Street 1:964 COUNTY ROAD T
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:WI
Practice Address - Zip Code:53559-9735
Practice Address - Country:US
Practice Address - Phone:608-988-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10899-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821386780Medicaid