Provider Demographics
NPI:1386866739
Name:JIM NICHOLS, DDS APDC
Entity Type:Organization
Organization Name:JIM NICHOLS, DDS APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-991-0766
Mailing Address - Street 1:401 SETTLERS TRACE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6048
Mailing Address - Country:US
Mailing Address - Phone:337-991-0766
Mailing Address - Fax:337-991-0594
Practice Address - Street 1:401 SETTLERS TRACE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6048
Practice Address - Country:US
Practice Address - Phone:337-991-0766
Practice Address - Fax:337-991-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty