Provider Demographics
NPI:1194737049
Name:NICHOLS, LINDA KAY (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAY
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 EUBANK BLVD NE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3465
Mailing Address - Country:US
Mailing Address - Phone:505-292-3933
Mailing Address - Fax:505-275-3374
Practice Address - Street 1:3900 EUBANK BLVD NE
Practice Address - Street 2:SUITE 11
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3465
Practice Address - Country:US
Practice Address - Phone:505-292-3933
Practice Address - Fax:505-275-3374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM13611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice