Provider Demographics
NPI:1154499382
Name:NICHOLS, JOHN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38058
Mailing Address - Country:US
Mailing Address - Phone:901-837-3455
Mailing Address - Fax:907-837-3465
Practice Address - Street 1:28 N TIPTON
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058
Practice Address - Country:US
Practice Address - Phone:901-837-3455
Practice Address - Fax:901-837-3465
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist