Provider Demographics
NPI:1740305291
Name:NICHOLS, EDWARD LEE (DDS)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:NICHOLS
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 1:720 E LATHAM AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4371
Mailing Address - Country:US
Mailing Address - Phone:951-929-4800
Mailing Address - Fax:951-929-1591
Practice Address - Street 1:720 E LATHAM AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4371
Practice Address - Country:US
Practice Address - Phone:951-929-4800
Practice Address - Fax:951-929-1591
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist