Individual
DR. NICOLE MARIE REDDOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1647 ADMIRAL TAUSSIG BLVD, NORFOLK, VA 23511-2803
(757) 953-8605
Mailing address
112 MERIDIAN PL, SUFFOLK, VA 23435-3787
(702) 374-8217
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0401415421
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0438000368
VA
Other
Enumeration date
04/19/2010
Last updated
01/30/2017
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