Provider Demographics
NPI:1326645623
Name:NICHOLSON, MARTHA DAWSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DAWSON
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 ASHLAND CITY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8331
Mailing Address - Country:US
Mailing Address - Phone:931-542-8742
Mailing Address - Fax:
Practice Address - Street 1:1021 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3302
Practice Address - Country:US
Practice Address - Phone:931-232-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113471223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health