Healthcare Provider Details

I. General information

NPI: 1205566411
Provider Name (Legal Business Name): NICOLE ELIZABETH PICKERELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ELIZABETH NUTTER DMD

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 PORTLAND ST
FRYEBURG ME
04037-1206
US

IV. Provider business mailing address

2 LINE DR
LIMINGTON ME
04049-3001
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-3133
  • Fax:
Mailing address:
  • Phone: 207-831-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4976
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: