DR. CHARLES THOMAS NUCKOLS D.M.D. NPI 1245244474

NPI Information

NPI: 1245244474
Provider Name: DR. CHARLES THOMAS NUCKOLS, D.M.D.
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

PECOS Registration: Yes

Address:
627 EASTWOOD AVE
BOWLING GREEN, KY
ZIP 42103
Phone: (270) 843-4341
Get Directions

DR. Charles Thomas Nuckols, D.M.D. is an oral and maxillofacial surgery dentist in Bowling Green, KY. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Charles Thomas Nuckols, D.M.D. NPI is 1245244474. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

627 EASTWOOD AVE
BOWLING GREEN, KY
ZIP 42103-688
Phone: (270) 843-4341
Fax: (270) 746-9551

The NPI 1245244474 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 7/27/2006 and was last updated on 1/10/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	204E00000X	Oral & Maxillofacial Surgery		3399	KENTUCKY	No
2	1223S0112X	Dentist	Oral and Maxillofacial Surgery	3399	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1115671	OTHER	KENTUCKY	PASSPORT GROUP PIN
2	64033996	MEDICAID	KENTUCKY
3	60033990	MEDICAID	KENTUCKY
4	6389	OTHER	KENTUCKY	DORAL DENTAL ID
5	000000212083	OTHER	KENTUCKY	ANTHEM PROVIDER ID
6	1069982	OTHER	KENTUCKY	PASSPORT HEALTH ID PIN
7	T53968	MEDICARE UPIN	KENTUCKY
8	1049801	MEDICARE ID-TYPE UNSPECIFIED	KENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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