Provider Demographics
NPI:1982749537
Name:NICHOLS, KIMBERLY JO (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JO
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DOVE RUN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3588
Mailing Address - Country:US
Mailing Address - Phone:859-268-6061
Mailing Address - Fax:859-266-6043
Practice Address - Street 1:1025 DOVE RUN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3588
Practice Address - Country:US
Practice Address - Phone:859-268-6061
Practice Address - Fax:859-266-6043
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist