Individual
DR. NICOLE MARIE SUDHOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
843 W GLEN AVE, PEORIA, IL 61614-4834
(309) 691-9421
Mailing address
843 W GLEN AVE, PEORIA, IL 61614-4834
(309) 691-9421
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028323
IL
Other
Enumeration date
04/20/2011
Last updated
04/20/2011
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