Individual
PATRICIA M NICKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6035 RIVERS AVE STE A, NORTH CHARLESTON, SC 29406-5018
(843) 572-9909
Mailing address
201 W 8TH ST, SUITE 810, PUEBLO, CO 81003-3038
(719) 562-4447
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-020038
OH
Other
Enumeration date
05/03/2007
Last updated
12/29/2010
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