MEDICARE: MRS. NICHOLE MICHELLE CAUWELS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	M 958	SD

General Provider Information

NPI Number	:	1588667141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICHOLE MICHELLE CAUWELS DDS

Provider Business Mailing Address
First Line	:	6100 W 41ST STREET
Second Line	:	SUITE 101
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106
Country	:	US
Telephone Number	:	605-361-1900
Fax Number	:	605-361-3599

Provider Business Practice Location Address
First Line	:	6100 W 41ST STREET
Second Line	:	SUITE 101
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106
Country	:	US
Telephone Number	:	605-361-1900
Fax Number	:	605-361-3599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/21/2010

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