Provider Demographics
NPI:1407982747
Name:NICHOLS, POLLY SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:POLLY
Middle Name:SUE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:POLLY
Other - Middle Name:SUE
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:37 FORESIDE RD
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1832
Mailing Address - Country:US
Mailing Address - Phone:207-798-6700
Mailing Address - Fax:
Practice Address - Street 1:37 FORESIDE RD
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1832
Practice Address - Country:US
Practice Address - Phone:207-798-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice