Healthcare Provider Details

I. General information

NPI: 1982568515
Provider Name (Legal Business Name): NICOLE H BUELL DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 KINGSBURY GRADE
STATELINE NV
89449-9804
US

IV. Provider business mailing address

PO BOX 4680
STATELINE NV
89449-4680
US

V. Phone/Fax

Practice location:
  • Phone: 775-580-7410
  • Fax: 775-580-7308
Mailing address:
  • Phone: 775-580-7410
  • Fax: 775-580-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KELLIE WARNICK
Title or Position: OFFICE MANAGER
Credential:
Phone: 775-580-7410