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General NPI Number Information
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NPI Number | 1699940064
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Entity Type | Organization
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Legal Business Name | JAMES S NICHOLSONDDS
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 730 CALLAHAN ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-5143
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Country | US
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Telephone | 918-682-6452
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Fax | 918-682-6505
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Provider Business Mailing Address
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Address Line | 730 CALLAHAN ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-5143
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Country | US
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Telephone | 918-682-6452
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Fax | 918-682-6505
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | DR. JAMES S NICHOLSON
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Credential | DDS
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Telephone | 918-682-6452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3655
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License Number State | OK
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