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General NPI Number Information
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NPI Number | 1457397432
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Entity Type | Organization
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Legal Business Name | LES E. NICHOLSON D.D.S. INC.
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2220 CHEAT RD
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City | MORGANTOWN
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State | WV
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Zip | 26508-4453
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Country | US
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Telephone | 304-594-1499
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Fax | 304-594-0150
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Provider Business Mailing Address
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Address Line | 2220 CHEAT RD
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City | MORGANTOWN
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State | WV
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Zip | 26508-4453
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Country | US
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Telephone | 304-594-1499
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Fax | 304-594-0150
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LES EDWARD NICHOLSON
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Credential | D.D.S.
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Telephone | 304-594-1499
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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 | 2331
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License Number State | WV
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