Individual
LESLIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
114 E BROOKWOOD ROAD, MIDFIELD, AL 35228
(205) 923-6828
(205) 923-1680
Mailing address
2103 STRATFORD RD SE, DECATUR, AL 35601-6641
(205) 923-6828
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3356
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
993983
UNITED CONCORDIA
PA
Enumeration date
11/28/2006
Last updated
07/08/2007
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