| Nichols Pediatric Dentistry Pllc | |
|
2055 Ken Pratt Blvd Unit B Longmont CO 80501-6554 | |
| (303) 776-1194 | |
| Not Available |
| Full Name | Nichols Pediatric Dentistry Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2055 Ken Pratt Blvd, Longmont, Colorado |
| Authorized Official Name and Position | Timothy Nichols (OWNER) |
| Authorized Official Contact | 3039940213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nichols Pediatric Dentistry Pllc 721 Judson St Longmont CO 80501-4818 Ph: (303) 994-0213 | Nichols Pediatric Dentistry Pllc 2055 Ken Pratt Blvd Unit B Longmont CO 80501-6554 Ph: (303) 776-1194 |
| NPI Number | 1881099935 |
|---|---|
| Provider Enumeration Date | 10/31/2014 |
| Last Update Date | 10/31/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881099935 | NPI | - | NPPES |
| 78080258 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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