Organization
CORNELIUS A. NICHOLSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORNELIUS A NICHOLSON DDS (PRESIDENT/ OWNER)
(206) 722-5000
Entity
Organization
Contact information
Practice address
2815 S MCCLELLAN ST, SEATTLE, WA 98144-5407
(206) 722-5000
(206) 721-1428
Mailing address
2815 S MCCLELLAN ST, SEATTLE, WA 98144-5407
(206) 722-5000
(206) 721-1428
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6379
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000830508
PROV# UNITED CORNCORDIA
WA
01
—
5055728
DSHS
WA
05
—
5055728
—
WA
Enumeration date
10/04/2006
Last updated
04/24/2008
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