Provider Demographics
NPI:1205566411
Name:PICKERELL, NICOLE ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:PICKERELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:NUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2 LINE DR
Mailing Address - Street 2:
Mailing Address - City:LIMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04049-3001
Mailing Address - Country:US
Mailing Address - Phone:207-831-9645
Mailing Address - Fax:
Practice Address - Street 1:44 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:FRYEBURG
Practice Address - State:ME
Practice Address - Zip Code:04037-1206
Practice Address - Country:US
Practice Address - Phone:207-935-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist