Provider Demographics
NPI:1932888039
Name:GERVASI, NICOLETTE ROSELI (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:ROSELI
Last Name:GERVASI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 137TH AVE NE APT 308
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4573
Mailing Address - Country:US
Mailing Address - Phone:425-281-2508
Mailing Address - Fax:
Practice Address - Street 1:35 148TH AVE SE STE 1
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5166
Practice Address - Country:US
Practice Address - Phone:425-746-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61465560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist