Provider Demographics
NPI:1457573750
Name:NICHOLSON, JAMES SIDNEY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SIDNEY
Last Name:NICHOLSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:SIDNEY
Other - Last Name:NICHOLSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:16675 COBBLESTONE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020
Mailing Address - Country:US
Mailing Address - Phone:918-260-4254
Mailing Address - Fax:
Practice Address - Street 1:1202 N STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73020
Practice Address - Country:US
Practice Address - Phone:918-260-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice