Provider Demographics
NPI:1942425632
Name:NICHOLSON, KATHRYN E (DMD, PC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 WASHBURN WAY SUITE 240
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-885-5578
Mailing Address - Fax:541-885-5453
Practice Address - Street 1:2650 WASHBURN WAY UNIT 240
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4593
Practice Address - Country:US
Practice Address - Phone:541-885-5578
Practice Address - Fax:541-885-5453
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist