Provider Demographics
NPI:1295344406
Name:NICOLE LECCI DENTAL, LLC
Entity type:Organization
Organization Name:NICOLE LECCI DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:JANINE
Authorized Official - Last Name:LECCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-670-0146
Mailing Address - Street 1:8910 INDIAN HILLS DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114
Mailing Address - Country:US
Mailing Address - Phone:402-397-3400
Mailing Address - Fax:
Practice Address - Street 1:8910 INDIAN HILLS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114
Practice Address - Country:US
Practice Address - Phone:402-397-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty