MEDICARE: DR. NICOLE FALLAHZADEH DMD

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	122300000X	Dentist	7878	KY

General Provider Information

NPI Number	:	1609935220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE FALLAHZADEH DMD

Provider Business Mailing Address
First Line	:	4384 CLEARWATER WAY STE 110
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40515-6479
Country	:	US
Telephone Number	:	859-913-4472
Fax Number	:

Provider Business Practice Location Address
First Line	:	4384 CLEARWATER WAY
Second Line	:	STE 110
City	:	LEXINGTON
State	:	KY
Zip	:	40515-6337
Country	:	US
Telephone Number	:	859-913-4472
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	09/18/2024

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