Provider Demographics
NPI:1275377731
Name:NICOLOSI, SOPHIA DANIELLE (DDS)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:DANIELLE
Last Name:NICOLOSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15006 SWANLEY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2535
Mailing Address - Country:US
Mailing Address - Phone:713-398-9465
Mailing Address - Fax:
Practice Address - Street 1:903 BAY AREA BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2648
Practice Address - Country:US
Practice Address - Phone:281-488-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX406551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice