MEDICARE: NICOLE DOCKERY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0004X	Dental Anesthesiology	GA2243	CA
2	122300000X	Dentist	DDS108667	CA

General Provider Information

NPI Number	:	1326709122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DOCKERY DDS

Provider Business Mailing Address
First Line	:	4410 PAXTON PL
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-3844
Country	:	US
Telephone Number	:	972-786-2685
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 PAXTON PL
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-3844
Country	:	US
Telephone Number	:	972-786-2685
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	12/08/2025

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