Provider Demographics
NPI:1134910599
Name:KING, NICOLE (RDH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 BLACK RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:MI
Mailing Address - Zip Code:48701-9779
Mailing Address - Country:US
Mailing Address - Phone:989-528-0314
Mailing Address - Fax:989-528-0314
Practice Address - Street 1:876 N VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9016
Practice Address - Country:US
Practice Address - Phone:989-331-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist