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General NPI Number Information
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NPI Number | 1205197647
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Entity Type | Organization
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Legal Business Name | MATTHEW NICHOLS DDS ORAL AND FACIAL SURGERY PLLC
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 1425 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2517
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Country | US
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Telephone | 931-954-5244
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW NICHOLS
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Credential | DDS
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Telephone | 931-954-5244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS0000009136
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License Number State | TN
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