Individual
NICOLE SUBERVILLE WASCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
22464 HIGHWAY 435, ABITA SPRINGS, LA 70420-2206
(985) 893-7835
(985) 893-3867
Mailing address
22464 HIGHWAY 435, ABITA SPRINGS, LA 70420-2206
(985) 893-7835
(985) 893-3867
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5288
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1852881
—
LA
Enumeration date
06/08/2007
Last updated
07/08/2007
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