Provider Demographics
NPI:1548354210
Name:NICHOLSON, BRADFORD EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:EUGENE
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 MAIN CT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1851
Mailing Address - Country:US
Mailing Address - Phone:970-963-1616
Mailing Address - Fax:970-963-1638
Practice Address - Street 1:889 MAIN CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1851
Practice Address - Country:US
Practice Address - Phone:970-963-1616
Practice Address - Fax:970-963-1638
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice