Healthcare Provider Details

I. General information

NPI: 1568015055
Provider Name (Legal Business Name): NICOLE CHRISTINE ANTOL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11015 N SCOTTSDALE RD STE 101
SCOTTSDALE AZ
85254-5196
US

IV. Provider business mailing address

16006 N 61ST PL
SCOTTSDALE AZ
85254-1985
US

V. Phone/Fax

Practice location:
  • Phone: 480-544-2800
  • Fax:
Mailing address:
  • Phone: 480-635-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD010446
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: