Provider Demographics
NPI:1780918458
Name:NICHOLSON, ASHLEY BROOKE (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:BROOKE
Last Name:NICHOLSON
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 1:1927 FAITHON P LUCAS SR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1698
Mailing Address - Country:US
Mailing Address - Phone:469-341-3888
Mailing Address - Fax:
Practice Address - Street 1:1927 FAITHON P LUCAS SR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1698
Practice Address - Country:US
Practice Address - Phone:469-341-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist