Organization
NICHOLS PEDIATRIC DENTISTRY PLLC
Active
Other names
Longmont Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY NICHOLS DDS (OWNER)
(303) 994-0213
Entity
Organization
Contact information
Practice address
2055 KEN PRATT BLVD, UNIT B, LONGMONT, CO 80501-6554
(303) 776-1194
Mailing address
721 JUDSON ST, LONGMONT, CO 80501-4818
(303) 994-0213
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78080258
—
CO
Enumeration date
10/31/2014
Last updated
10/31/2014
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