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General NPI Number Information
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NPI Number | 1598473431
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Entity Type | Individual
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Provider Name | ALIAH FUELLER NICHOLS DMD
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Gender | Female
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 3141 BEAUMONT CENTRE CIR STE 200
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City | LEXINGTON
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State | KY
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Zip | 40513-1956
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Country | US
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Telephone | 859-296-4846
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Fax |
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Provider Business Mailing Address
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Address Line | 105 SPRUCE ST
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City | LEXINGTON
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State | KY
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Zip | 40507-2109
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 123456
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License Number State | KY
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