Individual
DR. JACOB NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
163 PLEASANT AVE, PORTLAND, ME 04103-3242
(207) 771-2093
Mailing address
27 BUCA RUN, PORTLAND, ME 04103-1478
(207) 408-1001
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN4802
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN4802
MAINE DENTAL LICENSE
ME
Enumeration date
06/22/2020
Last updated
06/22/2020
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