MEDICARE: NICOLE DAHLKEMPER, DMD, PC

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	124Q00000X	Dental Hygienist
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1790090769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE DAHLKEMPER, DMD, PC

Provider Business Mailing Address
First Line	:	1203 TWO ISLAND CT
Second Line	:	SUITE 101
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7405
Country	:	US
Telephone Number	:	843-884-6166
Fax Number	:	843-884-1140

Provider Business Practice Location Address
First Line	:	1203 TWO ISLAND CT
Second Line	:	SUITE 101
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7405
Country	:	US
Telephone Number	:	843-884-6166
Fax Number	:	843-884-1140

Authorized Official
Title or Position	:	OWNER
Name	:	NICLE L DAHLKEMPER
Credential	:	DMD
Telephone Number	:	843-884-6166

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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