Provider Demographics
NPI:1790203560
Name:NICHOLS, WILLIAM G (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 DELTOP DR
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-5502
Mailing Address - Country:US
Mailing Address - Phone:360-961-7181
Mailing Address - Fax:
Practice Address - Street 1:2201 JAMES ST STE A
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4155
Practice Address - Country:US
Practice Address - Phone:360-734-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE607739391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice