Provider Demographics
NPI:1487968244
Name:LEADLEY, NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LEADLEY
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 1:135 TAMARRON DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2123
Mailing Address - Country:US
Mailing Address - Phone:719-352-6633
Mailing Address - Fax:719-352-6633
Practice Address - Street 1:1101 TELLER COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813
Practice Address - Country:US
Practice Address - Phone:719-689-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10245122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist