Provider Demographics
NPI:1366555682
Name:MCHARGUE, NICK JONES
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:JONES
Last Name:MCHARGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 BERRYVIEW CT.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-446-0956
Mailing Address - Fax:
Practice Address - Street 1:3301 BROADWAY BUSINESS PARK COURT
Practice Address - Street 2:STE. C
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-445-3630
Practice Address - Fax:573-445-3631
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0159151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO977525OtherUNITED CONCORDIA
MO127077OtherBLUECROSS BLUESHIELD
MO9178927OtherHEATHCARE USA