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General NPI Number Information
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NPI Number | 1205169034
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Entity Type | Individual
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Provider Name | NICOLE LEILA MACKIE DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 8840 W RUSSELL RD STE 210
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City | LAS VEGAS
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State | NV
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Zip | 89148-1355
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Country | US
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Telephone | 702-463-1300
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Fax | 702-463-4633
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Provider Business Mailing Address
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Address Line | 8840 W RUSSELL RD STE 210
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City | LAS VEGAS
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State | NV
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Zip | 89148-1355
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Country | US
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Telephone | 702-463-1300
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Fax | 702-463-4633
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN18071
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DI024233
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 055160-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | S543C
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License Number State | NV
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