Provider Demographics
NPI:1437496254
Name:NUCKOLS, THOMAS A (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:NUCKOLS
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 1:310 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-0057
Mailing Address - Country:US
Mailing Address - Phone:785-434-4565
Mailing Address - Fax:785-688-4105
Practice Address - Street 1:310 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-2231
Practice Address - Country:US
Practice Address - Phone:785-434-4565
Practice Address - Fax:785-688-4105
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS56891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice