Provider Demographics
NPI:1568539617
Name:NICHOLS, HOLLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2208
Mailing Address - Country:US
Mailing Address - Phone:541-296-9415
Mailing Address - Fax:
Practice Address - Street 1:308 E 4TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2208
Practice Address - Country:US
Practice Address - Phone:541-296-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist