Provider Demographics
NPI:1134820582
Name:HOUSHMAND, NICOLE NAZERANI (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:NAZERANI
Last Name:HOUSHMAND
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 1:14228 MIDWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3702
Mailing Address - Country:US
Mailing Address - Phone:972-852-2222
Mailing Address - Fax:972-852-1111
Practice Address - Street 1:14228 MIDWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3702
Practice Address - Country:US
Practice Address - Phone:972-852-2222
Practice Address - Fax:972-852-1111
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-07-11
Deactivation Date:2023-06-17
Deactivation Code:
Reactivation Date:2023-07-10
Provider Licenses
StateLicense IDTaxonomies
TX396751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice