Healthcare Provider Details

I. General information

NPI: 1326248535
Provider Name (Legal Business Name): CINDY B NICHOLS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RICHLAND MEDICAL PARK DR STE A
COLUMBIA SC
29203-6892
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6565
  • Fax: 803-434-6299
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-293-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN013380
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4218
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: