Provider Demographics
NPI:1184859100
Name:NICHOLSON, JOHN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:NICHOLSON
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 1:187 NEW HACKENSACK RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1726
Mailing Address - Country:US
Mailing Address - Phone:845-297-4030
Mailing Address - Fax:845-297-4031
Practice Address - Street 1:187 NEW HACKENSACK RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1726
Practice Address - Country:US
Practice Address - Phone:845-297-4030
Practice Address - Fax:845-297-4031
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0289111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice