Provider Demographics
NPI:1003300336
Name:NICHOLS, THOMAS STEVEN (DMD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STEVEN
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W LINCOLN HWY STE N
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6452
Mailing Address - Country:US
Mailing Address - Phone:219-769-6444
Mailing Address - Fax:219-755-4790
Practice Address - Street 1:500 W LINCOLN HWY STE N
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6452
Practice Address - Country:US
Practice Address - Phone:219-769-6444
Practice Address - Fax:219-755-4790
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012949A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice