Provider Demographics
NPI:1467611517
Name:NICHOLS, TIMOTHY DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:NICHOLS
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 1:721 JUDSON ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4818
Mailing Address - Country:US
Mailing Address - Phone:303-994-0213
Mailing Address - Fax:
Practice Address - Street 1:4383 TENNYSON ST
Practice Address - Street 2:1F
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2363
Practice Address - Country:US
Practice Address - Phone:303-423-4383
Practice Address - Fax:303-416-4420
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry