Provider Demographics
NPI:1780331322
Name:DU PREEZ, NICOLE ANTONIA
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANTONIA
Last Name:DU PREEZ
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 1:202 HONEYSUCKLE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4644
Mailing Address - Country:US
Mailing Address - Phone:803-394-8352
Mailing Address - Fax:
Practice Address - Street 1:7723 MISSISSIPPI AVE, BLDG #1561
Practice Address - Street 2:
Practice Address - City:FT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459
Practice Address - Country:US
Practice Address - Phone:337-531-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist