MEDICARE: DR. NICOLE VANDOREN DMD

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	1223G0001X	General Practice Dentistry	37826	TX

General Provider Information

NPI Number	:	1518636117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE VANDOREN DMD

Provider Business Mailing Address
First Line	:	729 JUNCTION DR APT A147
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-8654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3207 N US HIGHWAY 75
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2523
Country	:	US
Telephone Number	:	903-487-5647
Fax Number	:

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

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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