MEDICARE: DR. SPENCER CHONG NICHOLSON D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019025594	IL
2	1223G0001X	General Practice Dentistry	35977	TX

General Provider Information

NPI Number	:	1215978655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SPENCER CHONG NICHOLSON D.D.S

Provider Business Mailing Address
First Line	:	4533 DELAINA DR
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-0994
Country	:	US
Telephone Number	:	630-433-0135
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 NE MALL BLVD
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-4653
Country	:	US
Telephone Number	:	817-595-9675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	02/20/2021

Similar Medicare Providers

1093865545 — TRACIE DENISE SWAYDEN MD
Practice Location Address:

804 NE MALL BLVD
HURST, TX
76053-4653

Practice Phone: 817-595-4500
Practice Fax: 817-595-4505

1780838136 — KAREN S STICKA PA
Practice Location Address:

804 NE MALL BLVD
HURST, TX
76053-4653

Practice Phone: 817-595-4500
Practice Fax: 817-595-4505

1235366519 — SMILE CARE NORTHEAST, PLLC
Practice Location Address:

808 NE MALL BLVD
HURST, TX
76053-4653

Practice Phone: 817-595-9675
Practice Fax: 817-595-9677

1831410281 — DR. JUSTIN SCOTT ASHTON D.D.S.
Practice Location Address:

808 NE MALL BLVD
HURST, TX
76053-4653

Practice Phone: 817-595-9675
Practice Fax:

1285049924 — DR. KYLER D MCEWEN DMD
Practice Location Address:

808 NE MALL BLVD
HURST, TX
76053-4653

Practice Phone: 817-595-9675
Practice Fax:

1326424151 — LINDA HUA PA-C
Practice Location Address:

804 NE MALL BLVD
HURST, TX
76053-4653

Practice Phone: 817-592-9700
Practice Fax:

Directions to “ DR. SPENCER CHONG NICHOLSON D.D.S” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.