Provider Demographics
NPI:1801856000
Name:THOMAS A NUCKOLS DDS PA
Entity Type:Organization
Organization Name:THOMAS A NUCKOLS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:NUCKOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-434-4565
Mailing Address - Street 1:310 SW FIRST
Mailing Address - Street 2:PO BOX 57
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-0057
Mailing Address - Country:US
Mailing Address - Phone:785-434-4565
Mailing Address - Fax:785-688-4105
Practice Address - Street 1:310 SW FIRST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-0057
Practice Address - Country:US
Practice Address - Phone:785-434-4565
Practice Address - Fax:785-688-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS56891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116846OtherBLUE CROSS BLUE SHIELD