Healthcare Provider Details

I. General information

NPI: 1063432581
Provider Name (Legal Business Name): DR DANA M NICHOLS AND ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E LAKE AVE
NEW CARLISLE OH
45344
US

IV. Provider business mailing address

PO BOX 66 203 E LAKE AVE
NEW CARLISLE OH
45344
US

V. Phone/Fax

Practice location:
  • Phone: 937-845-9422
  • Fax: 937-845-8280
Mailing address:
  • Phone: 937-845-9422
  • Fax: 937-845-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21982
License Number StateOH

VIII. Authorized Official

Name: DR. DANA M NICHOLS
Title or Position: PRESIDENT OWNER
Credential: DMD
Phone: 937-845-9422