Provider Demographics
NPI:1477707784
Name:NUCKOLS & COHRON, P.S.C.
Entity Type:Organization
Organization Name:NUCKOLS & COHRON, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:NUCKOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-843-4341
Mailing Address - Street 1:627 EASTWOOD ST
Mailing Address - Street 2:P. O. BOX 70130
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1688
Mailing Address - Country:US
Mailing Address - Phone:270-843-4341
Mailing Address - Fax:270-746-9551
Practice Address - Street 1:627 EASTWOOD ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-1688
Practice Address - Country:US
Practice Address - Phone:270-843-4341
Practice Address - Fax:270-746-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1069982OtherPASSPORT HEALTH
KY64033996Medicaid
KY6389OtherDORAL
KY000000212083OtherANTHEM BCBS
KY60033990Medicaid
T53968Medicare UPIN
KY60033990Medicaid