Provider Demographics
NPI:1609666270
Name:VAN DAALEN, NICOLE KRISTINA (DDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINA
Last Name:VAN DAALEN
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 BOREALIS AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4G7V1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5855 E STILL CIRCLE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-248-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program