Provider Demographics
NPI:1922262732
Name:MARGAVITCH, NICOLE HELENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HELENE
Last Name:MARGAVITCH
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 1:120 S DENTON TAP RD STE 210
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5024
Mailing Address - Country:US
Mailing Address - Phone:888-749-3297
Mailing Address - Fax:
Practice Address - Street 1:6050 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-5613
Practice Address - Country:US
Practice Address - Phone:888-749-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0024080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1205032935OtherNPI NON-MEDICAID, NON-MEDICARE
TX1578623294OtherNPI NONMEDICAID, NONMEDICARE