Provider Demographics
NPI:1770339590
Name:NICOLE TRIPP DDS PLLC
Entity type:Organization
Organization Name:NICOLE TRIPP DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-963-3794
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358-0067
Mailing Address - Country:US
Mailing Address - Phone:320-963-3794
Mailing Address - Fax:320-547-4002
Practice Address - Street 1:33 BIRCH AVE S
Practice Address - Street 2:
Practice Address - City:MAPLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55358-4570
Practice Address - Country:US
Practice Address - Phone:320-963-3794
Practice Address - Fax:320-547-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental