Healthcare Provider Details

I. General information

NPI: 1225460181
Provider Name (Legal Business Name): NICOLE NAHAKU NAKASHIMA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355-B FACULTY DRIVE 10 DS/SGD
USAF ACADEMY CO
80840-1805
US

IV. Provider business mailing address

2355-B FACULTY DRIVE 10DS/SGD
COLORADO SPRINGS CO
80840-1805
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5192
  • Fax:
Mailing address:
  • Phone: 808-234-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00201796
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: