Provider Demographics
NPI:1578273165
Name:ELEISHA J NICKOLES, DDS, PLLC
Entity Type:Organization
Organization Name:ELEISHA J NICKOLES, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEISHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NICKOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-242-8600
Mailing Address - Street 1:1320 NATIONAL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5706
Mailing Address - Country:US
Mailing Address - Phone:304-242-8600
Mailing Address - Fax:304-242-8665
Practice Address - Street 1:1320 NATIONAL RD STE 1
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5706
Practice Address - Country:US
Practice Address - Phone:304-242-8600
Practice Address - Fax:304-242-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental