Provider Demographics
NPI:1033149893
Name:NICHOLS, MARK G (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-9798
Mailing Address - Country:US
Mailing Address - Phone:717-264-2011
Mailing Address - Fax:717-264-0169
Practice Address - Street 1:225 WALKER RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-9798
Practice Address - Country:US
Practice Address - Phone:717-264-2011
Practice Address - Fax:717-264-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031060L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1768456OtherMERC - UNITED CONC
PA1768458OtherMC - UNITED CONC
PA141448OtherCHAMBG - UNITED CONC