Provider Demographics
NPI:1356385678
Name:MCNICKLE, ZACHARY NORMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:NORMAN
Last Name:MCNICKLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4136
Mailing Address - Country:US
Mailing Address - Phone:405-624-3880
Mailing Address - Fax:405-624-3888
Practice Address - Street 1:2121 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4136
Practice Address - Country:US
Practice Address - Phone:405-624-3880
Practice Address - Fax:405-624-3888
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK856731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice