Healthcare Provider Details

I. General information

NPI: 1033890835
Provider Name (Legal Business Name): NICOLETTE ANN HECITA BULAON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16810 MERIDIAN E STE J107
PUYALLUP WA
98375-9604
US

IV. Provider business mailing address

23000 MILITARY RD S APT 3324
KENT WA
98032-1949
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-7777
  • Fax:
Mailing address:
  • Phone: 206-201-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61449731
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61449731
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: