Provider Demographics
NPI:1720421043
Name:HOOD, NICOLE WHITNEY
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:WHITNEY
Last Name:HOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:LIMON
Mailing Address - State:CO
Mailing Address - Zip Code:80828-0309
Mailing Address - Country:US
Mailing Address - Phone:719-775-8758
Mailing Address - Fax:719-775-0544
Practice Address - Street 1:170 E AVE.
Practice Address - Street 2:BOX 309
Practice Address - City:LIMON
Practice Address - State:CO
Practice Address - Zip Code:80828
Practice Address - Country:US
Practice Address - Phone:719-743-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002022141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice