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General NPI Number Information
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NPI Number | 1194457085
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Entity Type | Individual
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Provider Name | NICOLE ROSE DUBOIS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 5443 PLATT SPRINGS RD STE F
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City | LEXINGTON
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State | SC
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Zip | 29073-6203
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Country | US
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Telephone | 803-470-5067
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Fax |
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Provider Business Mailing Address
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Address Line | 2038 LAKE MURRAY BLVD APT 15208
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City | COLUMBIA
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State | SC
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Zip | 29212-0866
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Country | US
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Telephone | 757-243-3293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10260
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License Number State | SC
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