Provider Demographics
NPI:1114331253
Name:JOSEPH J. NICOLS JR DDS PC
Entity Type:Organization
Organization Name:JOSEPH J. NICOLS JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NICOLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-587-9766
Mailing Address - Street 1:714 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4421
Mailing Address - Country:US
Mailing Address - Phone:631-587-9766
Mailing Address - Fax:
Practice Address - Street 1:714 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4421
Practice Address - Country:US
Practice Address - Phone:631-587-9766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023442261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery