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General NPI Number Information
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NPI Number | 1467340430
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Entity Type | Individual
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Provider Name | JACOB F NICHOLS DMD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 2410 SAMPSON ST
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City | NORTH CHICAGO
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State | IL
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Zip | 60088-2942
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Country | US
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Telephone | 847-688-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 724 BLUEGRASS DR
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City | SPRING CREEK
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State | NV
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Zip | 89815-6946
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Country | US
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Telephone | 970-768-4204
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 14226710-9926
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License Number State | UT
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