Jerry Dallas Nichols, D.D.S.
Individual provider Active NPI General Practice Dentistry · Pearcy, AR
NPI 1285642876 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1285642876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1907 (AR)
- Practice address
- 3354 Old Airport Rd
Pearcy, AR 71964-9445 - Phone
- (501) 767-0011
- Fax
- (501) 767-5686
- NPI assigned
- Aug 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1907 | AR | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J. Michael Plyler, DDS, PA | Past | Accepting new patients | |
| Stan Ware, DDS PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1907 | AR | Yes |
Addresses
Primary practice location
3354 Old Airport Rd
Pearcy, AR 71964-9445
Mailing address
3354 Old Airport Rd
Pearcy, AR 71964-9445
Phone (501) 767-0011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 841975 | Other | AR | UNITED CONCORDIA NUMBER |
| 58471 | Other | AR | BLUE CROSS BLUE SHIELD |
Other providers in Pearcy, AR
- Lake Hamilton School District
- Julie Lynn Logan
- Debra D Loyd
- Natalie S. Manatt
- Susan Ann Murch
- Restore Healing Center LLC
- Jessica Roper
- Angy Rose
- Kristin Elizabeth Shults
- Stan Ware, DDS PA
All providers in Pearcy, AR · General Practice Dentistry in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.