Individual
DR. SUSANNE A NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
106 THIRD AVENUE SOUTHEAST, REFORM, AL 35481-2254
(205) 375-6314
Mailing address
P.O. BOX 672, 106 THIRD AVENUE SOUTHEAST, REFORM, AL 35481-2254
(205) 375-6314
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2813-94
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05778081
—
MS
01
—
2813
DELTA DENTAL
MS
01
—
954583
UNITED CONCORDIA DENTAL
MS
Enumeration date
10/16/2006
Last updated
04/04/2012
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