Healthcare Provider Details

I. General information

NPI: 1235665894
Provider Name (Legal Business Name): NICOLE DEAKINS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W LANCASTER AVE DEVON SQUARE II, SUITE 115
WAYNE PA
19087-2523
US

IV. Provider business mailing address

744 W LANCASTER AVE DEVON SQUARE II, SUITE 115
WAYNE PA
19087-2523
US

V. Phone/Fax

Practice location:
  • Phone: 610-971-0717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS041127
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: