Provider Demographics
NPI:1831921147
Name:STULL, NICOLE MARIE (DENTAL ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:STULL
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 STILLWELLS CORNER RD. SUITE C1
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-780-3300
Mailing Address - Fax:732-780-3301
Practice Address - Street 1:505 STILLWELLS CORNER RD. SUITE C1
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-780-3300
Practice Address - Fax:732-780-3301
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02593103122300000X
NJ22D102593103126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
No122300000XDental ProvidersDentist