Provider Demographics
NPI:1225145683
Name:EDE-NICHOLS, DIANE (DMD, MHL, MPH)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:EDE-NICHOLS
Suffix:
Gender:F
Credentials:DMD, MHL, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 NW 27TH AVENUE
Mailing Address - Street 2:SUITE D- 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4934
Mailing Address - Country:US
Mailing Address - Phone:786-318-2337
Mailing Address - Fax:786-906-1207
Practice Address - Street 1:7900 NW 27TH AVENUE
Practice Address - Street 2:SUITE E-12
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4934
Practice Address - Country:US
Practice Address - Phone:786-318-2337
Practice Address - Fax:786-906-1207
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN134191223G0001X
MO20210056811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice