Provider Demographics
NPI:1982773057
Name:NICHOLS, HENRY D (DDS)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:D
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 1:1401 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-8961
Mailing Address - Country:US
Mailing Address - Phone:810-724-8223
Mailing Address - Fax:
Practice Address - Street 1:216 E 3RD ST
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-1322
Practice Address - Country:US
Practice Address - Phone:810-724-8080
Practice Address - Fax:810-724-3309
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI121421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice