Individual
DR. JERRY DALLAS NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3354 OLD AIRPORT RD, PEARCY, AR 71964-9445
(501) 767-0011
(501) 767-5686
Mailing address
3354 OLD AIRPORT RD, PEARCY, AR 71964-9445
(501) 767-0011
(501) 767-5686
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1907
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58471
BLUE CROSS BLUE SHIELD
AR
01
—
841975
UNITED CONCORDIA NUMBER
AR
Enumeration date
08/03/2006
Last updated
07/08/2007
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