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General NPI Number Information
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NPI Number | 1780574160
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Entity Type | Individual
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Provider Name | CHRISTOPHER NUCKOLS DMD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 2441 21ST ST
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5582
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Country | US
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Telephone | 270-798-8751
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Fax |
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Provider Business Mailing Address
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Address Line | 16 THOMAS LN
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City | ESSEX
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State | VT
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Zip | 05452-2258
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Country | US
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Telephone | 802-760-7021
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016.0134372
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License Number State | VT
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