Provider Demographics
NPI:1558461673
Name:NICHOLSON, JAMES R (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1523
Mailing Address - Country:US
Mailing Address - Phone:317-873-6927
Mailing Address - Fax:317-873-0195
Practice Address - Street 1:95 E OAK ST
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1523
Practice Address - Country:US
Practice Address - Phone:317-873-6927
Practice Address - Fax:317-873-0195
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics