Provider Demographics
NPI:1932740271
Name:SEOK W. NICHOLS I, DDS, PS
Entity Type:Organization
Organization Name:SEOK W. NICHOLS I, DDS, PS
Other - Org Name:PUGET SOUND DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEOK
Authorized Official - Middle Name:W
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-627-2648
Mailing Address - Street 1:2607 BRIDGEPORT WAY W STE 1K
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4725
Mailing Address - Country:US
Mailing Address - Phone:253-627-2648
Mailing Address - Fax:253-533-7214
Practice Address - Street 1:2607 BRIDGEPORT WAY W STE 1K
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4725
Practice Address - Country:US
Practice Address - Phone:253-627-2648
Practice Address - Fax:253-533-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty