Provider Demographics
NPI:1942343108
Name:NELSON, NICOLE HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HARRIS
Last Name:NELSON
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 1:3325 DURHAM CHAPEL HILL BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2646
Mailing Address - Country:US
Mailing Address - Phone:919-489-0497
Mailing Address - Fax:
Practice Address - Street 1:1013 SPRING LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-718-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21512122300000X
NC105111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1942343108OtherDELTA DENTAL
NC1942343108Medicaid