Provider Demographics
NPI:1831348820
Name:TIM NICHOLS DDS INC
Entity type:Organization
Organization Name:TIM NICHOLS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-822-4447
Mailing Address - Street 1:HC 63 BOX 3560
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-9722
Mailing Address - Country:US
Mailing Address - Phone:304-822-4447
Mailing Address - Fax:304-822-7943
Practice Address - Street 1:HC 63 BOX 3560
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-9722
Practice Address - Country:US
Practice Address - Phone:304-822-4447
Practice Address - Fax:304-822-7943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty