Individual
LASHAWN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
1835 XIMENO AVE, LONG BEACH, CA 90815-2850
(310) 820-9933
(310) 820-0588
Mailing address
634 CEDAR AVE APT 7, LONG BEACH, CA 90802-1231
(562) 200-4771
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
63869
CA
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346610458
DENTICAL
CA
Enumeration date
10/01/2015
Last updated
02/03/2020
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