Organization
NUCKOLS & COHRON, P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES T NUCKOLS DMD (OWNER)
(270) 843-4341
Entity
Organization
Contact information
Practice address
627 EASTWOOD ST, BOWLING GREEN, KY 42103-1688
(270) 843-4341
(270) 746-9551
Mailing address
627 EASTWOOD ST, P. O. BOX 70130, BOWLING GREEN, KY 42103-1688
(270) 843-4341
(270) 746-9551
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3399
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000212083
ANTHEM BCBS
KY
01
—
1069982
PASSPORT HEALTH
KY
05
—
60033990
—
KY
01
—
6389
DORAL
KY
05
—
64033996
—
KY
Enumeration date
11/13/2008
Last updated
11/13/2008
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