Provider Demographics
NPI:1720120793
Name:NICHOLSON, THOMAS E JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:NICHOLSON
Suffix:JR
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 1:450 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2517
Mailing Address - Country:US
Mailing Address - Phone:973-467-0045
Mailing Address - Fax:973-467-9221
Practice Address - Street 1:450 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2517
Practice Address - Country:US
Practice Address - Phone:973-467-0045
Practice Address - Fax:973-467-9221
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16090122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice