Healthcare Provider Details

I. General information

NPI: 1033671862
Provider Name (Legal Business Name): ZACHARY JAMES NICHOLSON DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 HIGHWAY 70 S STE 104
NASHVILLE TN
37221-1758
US

IV. Provider business mailing address

7308 MIDDLEBROOK CIR
NASHVILLE TN
37221-6545
US

V. Phone/Fax

Practice location:
  • Phone: 615-441-1441
  • Fax:
Mailing address:
  • Phone: 920-946-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12806
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12806
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: