Individual
RUSSELL DEWITT NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
812 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-2079
(334) 347-9283
(334) 347-7664
Mailing address
108 E KINGSWOOD DR, ENTERPRISE, AL 36330-4119
(334) 347-9283
(334) 347-7664
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4810A1
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4810
DELTA
AL
01
—
487225
UNITED CONCORDIA
AL
01
—
51027316
BLUE CROSS BLUE SHIELD
AL
Enumeration date
06/05/2006
Last updated
04/08/2008
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