Provider Demographics
NPI:1104919927
Name:NICHOLS, CHRISTOPHER T (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:T
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 TARAVAL ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2365
Mailing Address - Country:US
Mailing Address - Phone:415-661-3989
Mailing Address - Fax:415-661-0479
Practice Address - Street 1:1539 TARAVAL ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2365
Practice Address - Country:US
Practice Address - Phone:415-661-3989
Practice Address - Fax:415-661-0479
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ347471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice