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General NPI Number Information
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NPI Number | 1114652625
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Entity Type | Individual
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Provider Name | NICHOLAS REX DMD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 660 E ROOSEVELT RD
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City | LOMBARD
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State | IL
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Zip | 60148-4776
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Country | US
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Telephone | 630-627-7651
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Fax |
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Provider Business Mailing Address
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Address Line | 22W284 TEMPLE DR
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City | MEDINAH
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State | IL
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Zip | 60157-9504
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Country | US
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Telephone | 630-536-7100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.033865
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License Number State | IL
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