Individual
NICOLE WAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 N BRIDGE ST STE C, LINDEN, MI 48451-8823
(810) 458-6188
Mailing address
16215 GRAND VIEW RD, FENTON, MI 48430-9194
(810) 458-6188
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
2901021150
MI
Other
Enumeration date
02/15/2013
Last updated
07/01/2025
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