Provider Demographics
NPI:1841594918
Name:LE, NICOLE WESTFALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:WESTFALL
Last Name:LE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:VAN LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11623 CANNINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-4398
Mailing Address - Country:US
Mailing Address - Phone:317-442-5411
Mailing Address - Fax:
Practice Address - Street 1:9105 E 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2229
Practice Address - Country:US
Practice Address - Phone:317-442-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist