Healthcare Provider Details

I. General information

NPI: 1326709122
Provider Name (Legal Business Name): NICOLE DOCKERY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 PAXTON PL
CALABASAS CA
91302-3844
US

IV. Provider business mailing address

4410 PAXTON PL
CALABASAS CA
91302-3844
US

V. Phone/Fax

Practice location:
  • Phone: 972-786-2685
  • Fax:
Mailing address:
  • Phone: 972-786-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberGA2243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS108667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: