MEDICARE: MR. JOHN LAWS NICKINS JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6054	MD

General Provider Information

NPI Number	:	1841272184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN LAWS NICKINS JR. DDS

Provider Business Mailing Address
First Line	:	2 E ROLLING CROSSROADS
Second Line	:	SUITE 57
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-6211
Country	:	US
Telephone Number	:	410-747-1830
Fax Number	:	410-747-1823

Provider Business Practice Location Address
First Line	:	2 E ROLLING CROSSROADS
Second Line	:	SUITE 57
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-6211
Country	:	US
Telephone Number	:	410-747-1830
Fax Number	:	410-747-1823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	07/08/2007

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