Healthcare Provider Details

I. General information

NPI: 1427113976
Provider Name (Legal Business Name): FRANK C. NICHOLS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE # MC-3905 UCONN SCHOOL OF DENTAL MEDICINE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

263 FARMINGTON AVE # MC-3905 UCONN SCHOOL OF DENTAL MEDICINE
FARMINGTON CT
06030-3905
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2364
  • Fax: 860-679-7507
Mailing address:
  • Phone: 860-679-2207
  • Fax: 860-679-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number006982
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: