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NPI Code Detail

MEDICARE: DR. ELIZABETH B NICHOLS DDS

MEDICARE: DR. ELIZABETH B NICHOLS DDS
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
1122300000XDentist45597CA

General Provider Information

NPI Number : 1255429296
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH B NICHOLS DDS
Provider Business Mailing Address
First Line : 2608 CONCORD BLVD
Second Line :
City : CONCORD
State : CA
Zip : 94519
Country : US
Telephone Number : 925-685-5764
Fax Number : 925-825-4514
Provider Business Practice Location Address
First Line : 2608 CONCORD BLVD
Second Line :
City : CONCORD
State : CA
Zip : 94519
Country : US
Telephone Number : 925-685-5764
Fax Number : 925-825-4514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 07/08/2007

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