Provider Demographics
NPI:1457438012
Name:PECORA, NIKOLE G (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:NIKOLE
Middle Name:G
Last Name:PECORA
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:NIKOLE
Other - Middle Name:G
Other - Last Name:PECORA YUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2898 BARCLAY WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-678-4951
Mailing Address - Fax:
Practice Address - Street 1:6035 EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-887-7200
Practice Address - Fax:517-877-1549
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI187241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics