Provider Demographics
NPI:1376627075
Name:NICHOLSON, CURTIS AUSTIN (DDS)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:AUSTIN
Last Name:NICHOLSON
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 1:2000 WEST CUTHBERT AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-682-9446
Mailing Address - Fax:432-684-7126
Practice Address - Street 1:2000 WEST CUTHBERT AVENUE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701
Practice Address - Country:US
Practice Address - Phone:432-682-9446
Practice Address - Fax:432-684-7126
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice