Healthcare Provider Details

I. General information

NPI: 1669676698
Provider Name (Legal Business Name): HOWARD C NICHOLS DENTIST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MAIN ST
AKRON NY
14001
US

IV. Provider business mailing address

PO BOX 87 165 MAIN ST
AKRON NY
14001
US

V. Phone/Fax

Practice location:
  • Phone: 716-542-2521
  • Fax: 716-542-2521
Mailing address:
  • Phone: 716-542-2521
  • Fax: 716-542-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number26550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: