MEDICARE: DR. ASHLEY NICHOLS

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	0401410238	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477630374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY NICHOLS

Provider Business Mailing Address
First Line	:	10813 COLONIST DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-5835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3824 MECHANICSVILLE PIKE
Second Line	:	UNIT #12
City	:	RICHMOND
State	:	VA
Zip	:	23223-1114
Country	:	US
Telephone Number	:	804-321-3023
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/09/2007

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