Provider Demographics
NPI:1881253581
Name:NICHOLS, DONNA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:LYNN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5011 SOUTHPARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7738
Mailing Address - Country:US
Mailing Address - Phone:919-240-7280
Mailing Address - Fax:919-869-1436
Practice Address - Street 1:1002 N CHURCH ST STE 400
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1450
Practice Address - Country:US
Practice Address - Phone:336-545-0161
Practice Address - Fax:336-697-6440
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1881253581Medicaid