Provider Demographics
NPI:1003019589
Name:NICOLETTE, JOHN LINDSAY (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LINDSAY
Last Name:NICOLETTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 W LAKE CIR N
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-6767
Mailing Address - Country:US
Mailing Address - Phone:303-795-7163
Mailing Address - Fax:303-789-2649
Practice Address - Street 1:3510 S MARION ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3951
Practice Address - Country:US
Practice Address - Phone:303-789-3455
Practice Address - Fax:303-789-2649
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice