Individual
DR. BROCK WESLEY NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3703 N KICKAPOO AVE, SHAWNEE, OK 74804-1703
(405) 275-0640
(405) 225-3008
Mailing address
10041 OAKWOOD DR, EDMOND, OK 73025-5007
(405) 436-5583
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7763
OK
1223G0001X
General Practice Dentistry
D11449
OR
Other
Enumeration date
07/16/2021
Last updated
03/05/2024
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