Provider Demographics
NPI:1699542266
Name:NICOLE J MANIGAULT DDS PLLC
Entity type:Organization
Organization Name:NICOLE J MANIGAULT DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANIGAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-835-3337
Mailing Address - Street 1:835 CLAREMONT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2488
Mailing Address - Country:US
Mailing Address - Phone:336-835-3337
Mailing Address - Fax:336-835-1241
Practice Address - Street 1:835 CLAREMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2488
Practice Address - Country:US
Practice Address - Phone:336-835-3337
Practice Address - Fax:336-835-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental