Provider Demographics
NPI:1538372891
Name:EBERLE, NICOLE ELIZABETH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:EBERLE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MADISON ST
Mailing Address - Street 2:#280
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5419
Mailing Address - Country:US
Mailing Address - Phone:303-320-0307
Mailing Address - Fax:
Practice Address - Street 1:55 MADISON ST
Practice Address - Street 2:#280
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5419
Practice Address - Country:US
Practice Address - Phone:303-320-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123421223X0400X
AK12151223X0400X
CO97871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics