Provider Demographics
NPI:1730330796
Name:ALDRIDGE, NYKKOL (DDS)
Entity type:Individual
Prefix:
First Name:NYKKOL
Middle Name:
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SOUTH TWINING ST. BLDG 760
Mailing Address - Street 2:42 ADOS/SGGN
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36112
Mailing Address - Country:US
Mailing Address - Phone:334-953-7822
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH TWINING ST. BLDG 760
Practice Address - Street 2:42 ADOS/SGGN
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist