| Organization Name: | NICOLE M JANE, DDS, MS, PC |
| NPI Number: | 1073840039 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE MARIE JANE (ORTHODONTIST/PRESIDENT) |
| Mailing Address: | 965 Tahoe Keys Blvd South Lake Tahoe |
| State: | CA US |
| Postal Code: | 961507161 |
| Phone Number: | 5305416585 |
| Fax Number: | |
| NPI Enumeration Date: | 11/12/2009 |
| NPI Last Update Date: | 11/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 53320 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |