DR. NICOLE MARIE REDDOUT (NPI# 1790001436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790001436 |
| Entity Type | Individual |
| Full Name | DR. NICOLE MARIE REDDOUT |
| Credential | DMD |
| Practice Address |
1647 Admiral Taussig Blvd Norfolk VA 23511-2803 |
| Mailing Address |
112 Meridian Pl Suffolk VA 23435-3787 |
| Practice Telephone | 7579538605 |
| Mailing Telephone | 7023748217 |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2017-01-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 0401415421 | VA | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
0438000368 | VA | Dental Providers |
| Street Address |
1647 ADMIRAL TAUSSIG BLVD |
| City | NORFOLK |
| State | VA |
| Zip Code | 23511-2803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962407775 | David A. Glass | Dentist | 1647 Admiral Taussig Blvd, Naval Dental Clinic, Norfolk, VA 23511-2803 | 2005-06-17 |
| 1386258564 | Ryan Huo | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-09-03 |
| 1699389312 | Stephen Shimp | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-09-01 |
| 1053925776 | Emil Alex Berkovich | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-09-01 |
| 1265043749 | Raymond Gozon | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-08-10 |
| 1427668789 | Travis Lee Hediger | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-08-03 |
| 1609485341 | Samer S. Gazale | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-07-29 |
| 1962011213 | Courtney Haron | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-07-23 |
| 1942818281 | Zachery J Pommer | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-07-22 |
| 1487262739 | Kristina Chang | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2020-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215591888 | Nash Richard Galvan | Military Health Care Provider | 456-462 Pocahontas St, Norfolk, VA 23511 | 2019-04-29 |
| 1578059481 | Hillary Anne Diffee | Dentist | Navsta Norfolk Sewells Point Branch Clinic, 1647 Admiral Taussig Blvd, Norfolk, VA 23511 | 2018-07-03 |
| 1154860237 | Alexander Blau | General Practice | 1751 Morris Street, Comnavsurflant - Medical Readiness Division, Norfolk, VA 23511 | 2017-02-22 |
| 1205188307 | Agnes Bautista Banias | Dental Hygienist | 1647 Admiral Taussig Blvd Br Health Clinic, Naval Medical Center Portsmouth, Norfolk, VA 23511 | 2012-10-12 |
| 1891052676 | Conor Francis Hynes | Surgery | 1530 Gilbert St Ste 2000, Norfolk, VA 23511 | 2012-04-18 |
| 1871867747 | Brian Joseph Kennerley | Surgery | U. S. Marine Corps Forces Command, 1775 Forrestal Drive Bldg 33, Norfolk, VA 23511 | 2012-02-23 |
| 1053629964 | Shawnly Heath Ward | Military Health Care Provider | Surface Warfare Medical Institute - East, 459 Bellinger Blvd, Norfolk, VA 23511 | 2010-09-14 |
| 1225351760 | Jocelyn Martinezdelgado | Military Health Care Provider | 8857 1st Street, Pcu Jason Dunham Suite 400, Norfolk, VA 23511 | 2010-03-11 |
| 1245480854 | Vanessa O Hofilena | Dentist | 1647 Admiral Taussig Boulevard, Naval Medical Center Portsmouth - Dental Center, Norfolk, VA 23511 | 2008-09-19 |
| 1780833954 | Cecilia M Brownblake | Dentist | 1647 Admiral Taussig Blvd., Norfolk, VA 23511 | 2008-09-12 |
| Find all providers in zip 23511 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437210374 | Gary Alan Flower | Dentist | 2501 Lakeridge Drive, Suite 100, Norfolk, NE 68701-2558 | 2006-12-13 |
| 1003893009 | Daniel James Convey | Dentist | 2304 Taylor Ave, Norfolk, NE 68701-4537 | 2005-12-30 |
| 1558358960 | Mark Anthony Larusso | Dentist | 1647 Taussig Boulevard, Naval Dental Clinic Norfolk, Norfolk, VA 23511-2896 | 2005-09-30 |
| 1821368747 | James E. Krochmal Dds, P. C. | Dentist | 400 W Brambleton Ave, Suite 310, Norfolk, VA 23510-1115 | 2012-01-09 |
| 1891096814 | Oral Surgery Center, P.C. | Dentist | 2304 Taylor Ave, Norfolk, NE 68701-4537 | 2010-11-08 |
| 1083863633 | Sandra M. Halterman | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511 | 2008-09-18 |
| 1053598854 | Oral Surgery Center PC | Dentist | 2501 Lakeridge Dr, Norfolk, NE 68701 | 2008-01-24 |
| 1386837748 | Robert L Smith | Dentist | 302 W Phillip Ave, Norfolk, NE 68701-5248 | 2007-08-20 |
| 1346343753 | Gregory S Sears | Dentist | 109 N 29th St, Norfolk, NE 68701-3261 | 2006-09-07 |
| 1114958410 | Michael M Carson Sr. | Dentist | 1647 Admiral Taussig Blvd, Norfolk, VA 23511-2803 | 2006-07-05 |
| Find all providers in NORFOLK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.