Organization
LES E. NICHOLSON D.D.S. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LES EDWARD NICHOLSON D.D.S. (PRESIDENT)
(304) 329-1691
Entity
Organization
Contact information
Practice address
112 E COURT ST, KINGWOOD, WV 26537-1437
(304) 329-1691
(304) 329-3382
Mailing address
PO BOX 486, KINGWOOD, WV 26537-0486
(304) 329-1691
(304) 329-3382
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2331
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0136227001
—
WV
01
—
42673
UNITED CONCORDIA CORP #
WV
Enumeration date
07/06/2006
Last updated
08/22/2020
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