Provider Demographics
NPI:1871942169
Name:DR. NIKOLINA NIELSEN
Entity type:Organization
Organization Name:DR. NIKOLINA NIELSEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-864-0310
Mailing Address - Street 1:3850 SO MERIDIAN #5
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373
Mailing Address - Country:US
Mailing Address - Phone:253-864-0310
Mailing Address - Fax:
Practice Address - Street 1:3850 S MERIDIAN STE 5
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3701
Practice Address - Country:US
Practice Address - Phone:253-864-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW SMILES DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60146593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty