Provider Demographics
NPI:1508861931
Name:NUCKOLS, GLENDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:
Last Name:NUCKOLS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 FM 3237
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5324
Mailing Address - Country:US
Mailing Address - Phone:512-847-8934
Mailing Address - Fax:512-847-6262
Practice Address - Street 1:181 FM 3237
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-5324
Practice Address - Country:US
Practice Address - Phone:512-847-8934
Practice Address - Fax:512-847-6262
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist