Provider Demographics
NPI:1356023352
Name:CARR, NICOLE KRYSTEN (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KRYSTEN
Last Name:CARR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:KRYSTEN
Other - Last Name:KOWALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:566 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6355
Mailing Address - Country:US
Mailing Address - Phone:847-202-0033
Mailing Address - Fax:
Practice Address - Street 1:566 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6355
Practice Address - Country:US
Practice Address - Phone:847-202-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190344071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice