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DR. SUSANNE A NICHOLS D.M.D.

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1518047513

Individual Registrant:
DR. SUSANNE A NICHOLS D.M.D.
Gender: F
Sole Proprietor

Location and contact information for practice:
106 THIRD AVENUE SOUTHEAST  REFORM, AL 35481-2254 US
Tel: 205-375-6314  Fax: --

Contact information for business:
P.O. BOX 672 106 THIRD AVENUE SOUTHEAST REFORM, AL 35481-2254 US
Tel: 205-375-6314  Fax: --

Registration Information:
NPI: 1518047513
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
MS2813-94

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
DELTA DENTAL2813MS01
UNITED CONCORDIA DENTAL954583MS01
05778081MS05




HEALTH CARE JOBS AL - Page 1



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