Provider Demographics
NPI:1033345376
Name:NICHOLS, DONALD ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANTHONY
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2018
Mailing Address - Country:US
Mailing Address - Phone:316-321-0300
Mailing Address - Fax:316-321-1010
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2018
Practice Address - Country:US
Practice Address - Phone:316-321-0300
Practice Address - Fax:316-321-1010
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice