Provider Demographics
NPI:1134196512
Name:NICOLDS, TAMMY JAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JAYNE
Last Name:NICOLDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:JAYNE
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:602 HICKORY ST STE B
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5044
Mailing Address - Country:US
Mailing Address - Phone:325-480-3517
Mailing Address - Fax:
Practice Address - Street 1:602 HICKORY ST STE B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5044
Practice Address - Country:US
Practice Address - Phone:325-480-3517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist