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General NPI Number Information
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NPI Number | 1184368953
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Entity Type | Organization
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Legal Business Name | BRENT O NICHOLS DDS APC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 18800 DELAWARE ST STE 600
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-6017
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Country | US
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Telephone | 714-960-2600
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Fax | 714-960-2699
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Provider Business Mailing Address
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Address Line | 18800 DELAWARE ST STE 600
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-6017
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Country | US
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Telephone | 714-724-9072
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Fax | 714-960-2699
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | DR. BRENT O NICHOLS
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Credential | DDS
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Telephone | 714-724-9072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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