Provider Demographics
NPI:1437177185
Name:NICKLOW, RHEA A (MS, DMD)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:A
Last Name:NICKLOW
Suffix:
Gender:F
Credentials:MS, DMD
Other - Prefix:
Other - First Name:RHEA
Other - Middle Name:A
Other - Last Name:NICKLOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, DMD
Mailing Address - Street 1:6521 CRABTREE LANE
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141
Mailing Address - Country:US
Mailing Address - Phone:440-845-7900
Mailing Address - Fax:440-845-7969
Practice Address - Street 1:7043 PEARL RD STE 210
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4976
Practice Address - Country:US
Practice Address - Phone:440-845-7900
Practice Address - Fax:440-845-7969
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0221501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice