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General NPI Number Information
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NPI Number | 1811264161
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Entity Type | Organization
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Legal Business Name | RICK J NICHOLS DDS INC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 104 E OLIVE AVE SUITE 200
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-798-0604
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Fax | 909-798-9765
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Provider Business Mailing Address
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Address Line | 104 E OLIVE AVE SUITE 200
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-798-0604
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Fax | 909-798-9765
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RICK J NICHOLS
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Credential | DDS
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Telephone | 909-798-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 40973
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License Number State | CA
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