Provider Demographics
NPI:1205197886
Name:NICHOLS, COREY C (DDS)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:C
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 1:920 W EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4472
Mailing Address - Country:US
Mailing Address - Phone:479-751-8780
Mailing Address - Fax:479-751-0465
Practice Address - Street 1:920 W EMMA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4472
Practice Address - Country:US
Practice Address - Phone:479-751-8780
Practice Address - Fax:479-751-0465
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist