Provider Demographics
NPI:1396903829
Name:WEDDELL, NICOLE KATHLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KATHLEEN
Last Name:WEDDELL
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 1:9944 ESTEP DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1588
Mailing Address - Country:US
Mailing Address - Phone:317-569-9309
Mailing Address - Fax:
Practice Address - Street 1:3737 N MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4348
Practice Address - Country:US
Practice Address - Phone:317-924-5359
Practice Address - Fax:317-920-4391
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011147A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist