MEDICARE: DR. RICHARD ALDEN NICHOLS DMD

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	1223P0300X	Periodontics	18477	TX

General Provider Information

NPI Number	:	1831173624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALDEN NICHOLS DMD

Provider Business Mailing Address
First Line	:	US ARMY DENTAL ACTIVITY BAVARIA
Second Line	:	UNIT 28038
City	:	APO
State	:	AE
Zip	:	09112
Country	:	US
Telephone Number	:	011499662834738
Fax Number	:

Provider Business Practice Location Address
First Line	:	US ARMY DENTAL ACTIVITY BAVARIA
Second Line	:	UNIT 28038
City	:	APO
State	:	AE
Zip	:	09112
Country	:	US
Telephone Number	:	011499662834738
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	09/24/2014

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