Provider Demographics
NPI:1316681901
Name:CAREW, NICKETTA MELLISA (RDH)
Entity type:Individual
Prefix:MS
First Name:NICKETTA
Middle Name:MELLISA
Last Name:CAREW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4423
Mailing Address - Country:US
Mailing Address - Phone:917-754-0154
Mailing Address - Fax:
Practice Address - Street 1:1049 RUTLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-2942
Practice Address - Country:US
Practice Address - Phone:718-709-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031891124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty