Provider Demographics
NPI:1437177185
Name:NICKLOW, RHEA A (MS, DMD)
Entity type:Individual
Prefix:
First Name:RHEA
Middle Name:A
Last Name:NICKLOW
Suffix:
Gender:F
Credentials:MS, DMD
Other - Prefix:
Other - First Name:RHEA
Other - Middle Name:A
Other - Last Name:NICKLOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, DMD
Mailing Address - Street 1:1611 AKRON PENINSULA RD STE B
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7931
Mailing Address - Country:US
Mailing Address - Phone:330-928-7774
Mailing Address - Fax:440-845-7969
Practice Address - Street 1:1611 AKRON PENINSULA RD STE B
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7931
Practice Address - Country:US
Practice Address - Phone:330-928-7774
Practice Address - Fax:330-928-0898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0221501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice