# THOMAS A NUCKOLS DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801856000
- **Authorized official:** THOMAS ARTHUR NUCKOLS DDS (PRESIDENT)
- **Authorized official phone:** (785) 434-4565

## Contact information

- **Practice address:** 310 SW FIRST, PLAINVILLE, KS 67663-0057
- **Practice address phone:** (785) 434-4565
- **Practice address fax:** (785) 688-4105
- **Mailing address:** 310 SW FIRST, PO BOX 57, PLAINVILLE, KS 67663-0057
- **Mailing address phone:** (785) 434-4565
- **Mailing address fax:** (785) 688-4105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5689 | KS | Yes |

## Other

- **Enumeration date:** 03/23/2006
- **Last updated:** 01/10/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 116846 | BLUE CROSS BLUE SHIELD | KS |