Provider Demographics
NPI:1699660241
Name:CASEY, NICOLE ANN (DDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:CASEY
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 1:18921 EXPLORER TRL
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3238
Mailing Address - Country:US
Mailing Address - Phone:612-803-0160
Mailing Address - Fax:
Practice Address - Street 1:808 3RD ST SE STE 330
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-2449
Practice Address - Country:US
Practice Address - Phone:320-348-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND152761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice