Individual provider · Type 1 NPI

Nicole Marie Reddout, DMD

Oral and Maxillofacial Surgery (Dentist) · Norfolk, VA

NPI number 1790001436 Active

Practice location

1647 Admiral Taussig Blvd
Norfolk, VA 23511-2803

Mailing address

112 Meridian Pl
Suffolk, VA 23435-3787

Specialties and licenses

TaxonomyCodeLicense
Oral and Maxillofacial Surgery (Dentist) Primary 1223S0112X0438000368 (VA)
Dentist 122300000X0401415421 (VA)

Oral and Maxillofacial Surgery (Dentist): 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.

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About NPI 1790001436

Nicole Marie Reddout, DMD's National Provider Identifier is 1790001436, issued on Apr 19, 2010. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Norfolk, VA. The record was last updated on Jan 30, 2017.