Provider Demographics
NPI:1710185293
Name:WOODWARD, NICHOLAS C (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:C
Last Name:WOODWARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1404 N 203RD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2241
Mailing Address - Country:US
Mailing Address - Phone:402-289-1574
Mailing Address - Fax:402-289-1982
Practice Address - Street 1:1404 N 203RD ST STE 102
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2241
Practice Address - Country:US
Practice Address - Phone:402-289-1574
Practice Address - Fax:402-289-1982
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE66951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry