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DR. SUSANNE A NICHOLS D.M.D.
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1518047513
Individual Registrant:DR. SUSANNE A NICHOLS D.M.D.
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
106 THIRD AVENUE SOUTHEAST REFORM, AL 35481-2254 US
Tel: 205-375-6314 Fax: --
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: --
Tel: 205-375-6314 Fax: --
Registration Information:
NPI: 1518047513
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | MS | 2813-94 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| DELTA DENTAL | 2813 | MS | 01 |
| UNITED CONCORDIA DENTAL | 954583 | MS | 01 |
| 05778081 | MS | 05 |
