Individual
DR. BRANTLEY PAUL NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
840 N OAK AVE, RULEVILLE, MS 38771-3227
(601) 624-8209
Mailing address
PO BOX 10270, GREENWOOD, MS 38930-0270
(601) 624-8209
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3560-10
MS
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
8276
KY
Other
Enumeration date
07/14/2008
Last updated
08/14/2019
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