Individual
NICOLE MAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
3140 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 445-5959
(928) 445-5958
Mailing address
3140 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 445-5959
(928) 445-5958
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H007639
AZ
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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