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General NPI Number Information
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NPI Number | 1225460181
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Entity Type | Individual
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Provider Name | NICOLE NAHAKU NAKASHIMA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 2355-B FACULTY DRIVE 10 DS/SGD
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City | USAF ACADEMY
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State | CO
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Zip | 80840-1805
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Country | US
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Telephone | 719-333-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 2355-B FACULTY DRIVE 10DS/SGD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80840-1805
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Country | US
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Telephone | 808-234-8312
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00201796
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License Number State | CO
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