Nicolet Derose in Racine - Pediatric Dentistry
Nicolet Derose - NPI 1194892166
Nicolet Derose is a Pediatric Dentistry in Racine, Wisconsin. Nicolet Derose practices all healthcare services and medical treatments related to Pediatric Dentistry. The NPI Number for Nicolet Derose is 1194892166. The last update date is 2007-07-08.
Nicolet Derose's current location address is 316 5th St, Racine, Wisconsin. You can contact this provider via phone number 2625348662. The mailing address for Nicolet Derose is 316 5th St, Racine, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Nicolet Derose |
|---|---|
| Address | 316 5th St, Racine, Wisconsin |
| Phone Number | 2625348662 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | D.D.S |
NPI Number Detail
| NPI Number | 1194892166 |
|---|---|
| Provider Enumeration Date | 2006-11-29 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 316 5th St |
|---|---|
| City | Racine |
| State | Wisconsin (WI) |
| Post Code | 534034606 |
| Phone Number | 2625348662 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Pediatric Dentistry |
|---|---|
| Taxonomy | 1223P0221X |
| Licence No | 2362 |
|
Definition: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
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What is the unique identifier code issued to Nicolet Derose by the Centers for Medicare & Medicaid Services (CMS)?
The Nicolet Derose has been assigned the NPI (National Provider Identifier) 1194892166. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Where is the Nicolet Derose located?
The Nicolet Derose is located at 316 5Th St, Racine, WI 534034606.
What is Nicolet Derose's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Nicolet Derose is Pediatric Dentistry, and the taxonomy code that categorizes this field of expertise is 1223P0221X.
On what date did the Centers for Medicare & Medicaid Services issue the 1194892166 to Nicolet Derose?
The Nicolet Derose received its 1194892166 assignment from the Centers for Medicare & Medicaid Services on 2006-11-29.
As of what date were the details pertaining to Nicolet Derose last refreshed?
The information related to the Nicolet Derose, including its address, specialty, and other relevant details, was last updated on 2007-07-08.