Basic Information
| Provider Information | |||||||||
| NPI: | 1518488451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OCHOA | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2206 KNOXHILL VW SE | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300825253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044474039 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2268 EAST MAIN STREET, HWY 78 | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709724436 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2017 | ||||||||
| LastUpdateDate: | 06/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN015404 | GA | Y | Dental Providers | Dentist | General Practice |
No ID Information.