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General NPI Number Information
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NPI Number | 1528153343
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Entity Type | Organization
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Legal Business Name | CORNELIUS A. NICHOLSON
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 2815 S MCCLELLAN ST
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City | SEATTLE
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State | WA
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Zip | 98144-5407
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Country | US
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Telephone | 206-722-5000
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Fax | 206-721-1428
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Provider Business Mailing Address
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Address Line | 2815 S MCCLELLAN ST
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City | SEATTLE
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State | WA
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Zip | 98144-5407
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Country | US
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Telephone | 206-722-5000
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Fax | 206-721-1428
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | DR. CORNELIUS A NICHOLSON
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Credential | DDS
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Telephone | 206-722-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 6379
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License Number State | WA
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