Individual
KATELYN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1880 LANCASTER DR NE STE 121, SALEM, OR 97305-1069
(971) 600-3498
Mailing address
1880 LANCASTER DR NE STE 121, SALEM, OR 97305-1069
(971) 600-3498
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10277
OR
1223D0001X
Public Health Dentistry
D10277
OR
Other
Enumeration date
07/20/2015
Last updated
03/21/2022
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