Provider Demographics
NPI:1992031512
Name:NIELSEN, NIKOLINA PETRASEVIC (DMD)
Entity Type:Individual
Prefix:
First Name:NIKOLINA
Middle Name:PETRASEVIC
Last Name:NIELSEN
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 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:DENTAL CLINIC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2334
Mailing Address - Fax:206-768-5382
Practice Address - Street 1:1211 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1416
Practice Address - Country:US
Practice Address - Phone:253-863-4400
Practice Address - Fax:206-768-5382
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601465931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice