Provider Demographics
NPI:1811264161
Name:RICK J NICHOLS DDS INC
Entity type:Organization
Organization Name:RICK J NICHOLS DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-798-0604
Mailing Address - Street 1:104 E OLIVE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-798-0604
Mailing Address - Fax:909-798-9765
Practice Address - Street 1:104 E OLIVE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-798-0604
Practice Address - Fax:909-798-9765
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICK J NICHOLS DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-30
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA409731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty