Provider Demographics
NPI:1689608069
Name:NICHOLAS, JANICE BREAUX (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:BREAUX
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3829
Mailing Address - Country:US
Mailing Address - Phone:423-476-4418
Mailing Address - Fax:423-476-0189
Practice Address - Street 1:40 25TH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3829
Practice Address - Country:US
Practice Address - Phone:423-476-4418
Practice Address - Fax:423-476-0189
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0042351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice