Provider Demographics
NPI:1285165571
Name:NOLET, MICHELE PONDELICK (DDS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:PONDELICK
Last Name:NOLET
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:PONDELICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10201 WASHINGTONIAN BLVD APT 326
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-8306
Mailing Address - Country:US
Mailing Address - Phone:610-299-1524
Mailing Address - Fax:
Practice Address - Street 1:8175 WESTSIDE BLVD STE A
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2708
Practice Address - Country:US
Practice Address - Phone:443-390-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty