Provider Demographics
NPI:1083646475
Name:NICHOLS, SEOK WHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEOK
Middle Name:WHAN
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 1:5050 STATE HIGHWAY 303 NE STE 123
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3694
Mailing Address - Country:US
Mailing Address - Phone:360-377-9800
Mailing Address - Fax:360-203-7992
Practice Address - Street 1:5050 STATE HIGHWAY 303 NE
Practice Address - Street 2:SUITE 123
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3629
Practice Address - Country:US
Practice Address - Phone:360-377-9800
Practice Address - Fax:360-377-6192
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000102241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20-5559715OtherEIN