Individual
MATTHEW LEE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1425 MCARTHUR ST, MANCHESTER, TN 37355-2517
(931) 954-5244
Mailing address
105 JENNINGS CIR, TULLAHOMA, TN 37388-8853
(931) 581-8188
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS0000009136
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS0000009136
TN
Other
Enumeration date
04/12/2008
Last updated
06/01/2012
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