Provider Demographics
NPI:1740002922
Name:WHARFF, NICOLE P (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:P
Last Name:WHARFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7247 N HAMILTON AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2028
Mailing Address - Country:US
Mailing Address - Phone:773-986-5549
Mailing Address - Fax:
Practice Address - Street 1:15 W 136TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2104
Practice Address - Country:US
Practice Address - Phone:212-939-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program