Nichols, Susanne A

Nichols, Susanne A is an sole proprietor health care provider with primary practice located at 106 Third Avenue Southeast , Reform AL 35481-2254. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Nichols, Susanne A can be contacted via phone (205) 375-6314.

Contact Information

Primary practice address
106 Third Avenue Southeast Reform AL 35481-2254
Phone: (205) 375-6314
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 2813-94 Mississippi

Profile Details

NPI number 1518047513
LBN Legal business name Nichols, Susanne A
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 16th, 2006
Last updated Apr 4th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518047513 NPPES
Mississippi MEDICAID 05778081
Mississippi Other 954583
Mississippi Other 2813

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