Healthcare Provider Details

I. General information

NPI: 1427259175
Provider Name (Legal Business Name): NICOLE LAMBERT HURCOMB D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE KRISTIN LAMBERT D.D.S.

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51584 STATE ROAD 933
SOUTH BEND IN
46637-1704
US

IV. Provider business mailing address

51584 STATE ROAD 933
SOUTH BEND IN
46637-1704
US

V. Phone/Fax

Practice location:
  • Phone: 574-272-6575
  • Fax: 574-272-6587
Mailing address:
  • Phone: 574-272-6575
  • Fax: 574-272-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12010971A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010971A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: