Provider Demographics
NPI:1962609404
Name:MAIRS, NICHOLE JANINE (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:JANINE
Last Name:MAIRS
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 1:6355 WARD RD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004
Mailing Address - Country:US
Mailing Address - Phone:303-420-3310
Mailing Address - Fax:303-422-3599
Practice Address - Street 1:6355 WARD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004
Practice Address - Country:US
Practice Address - Phone:303-420-3310
Practice Address - Fax:303-422-3599
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice