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General NPI Number Information
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NPI Number | 1134341407
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Entity Type | Organization
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Legal Business Name | NICHOLS PERIODONTICS LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2401 5TH STREET NORTH SUITE 2
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City | COLUMBUS
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State | MS
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Zip | 39705
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Country | US
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Telephone | 662-713-1111
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Fax | 662-713-1113
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Provider Business Mailing Address
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Address Line | 2401 5TH STREET NORTH SUITE 2
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City | COLUMBUS
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State | MS
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Zip | 39705
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Country | US
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Telephone | 662-713-1111
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Fax | 662-713-1113
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY TODD NICHOLS
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Credential | D.M.D
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Telephone | 662-713-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2882-95
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License Number State | MS
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