Provider Demographics
NPI:1427284165
Name:STAMAN, NICOLE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:STAMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:QUISENBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1401 RIVERPLACE BLVD
Mailing Address - Street 2:#911
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9069
Mailing Address - Country:US
Mailing Address - Phone:904-238-1021
Mailing Address - Fax:
Practice Address - Street 1:1400 ANNUNCIATION ST
Practice Address - Street 2:APT #1203
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-8646
Practice Address - Country:US
Practice Address - Phone:813-476-5774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist