Provider Demographics
NPI:1154179737
Name:MARCHESE, NICOLE (RDH, LDH)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:RDH, LDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9152
Mailing Address - Country:US
Mailing Address - Phone:630-670-4908
Mailing Address - Fax:
Practice Address - Street 1:1934 45TH ST
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3917
Practice Address - Country:US
Practice Address - Phone:219-595-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.014497124Q00000X
IN13007586A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist