Individual
DR. NICOLE ELIZABETH EASTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
9510 BONITA BEACH RD SE, SUITE 101, BONITA SPRINGS, FL 34135-4699
(610) 657-1329
Mailing address
20506 BLACK TREE LN, ESTERO, FL 33928-6460
(610) 657-1329
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
RESIDENCYPERMIT:1053
FL
1223P0221X
Pediatric Dentistry
Primary
DN20011
FL
Other
Enumeration date
07/02/2012
Last updated
09/14/2016
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