| NPI | 1578273165 |
|---|---|
| Former Legal Business Name | ELEISHA J NICKOLES, DDS |
| Entity Type | Organization |
| Authorized Contact | ELEISHA JEAN NICKOLES President 304-242-8600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |