Individual
JASON DEWAYNE NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6151 HWY 411, BENTON, TN 37307
(423) 338-8519
(423) 338-8576
Mailing address
PO BOX 669, BENTON, TN 37307
(423) 338-8519
(423) 338-8576
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7391
TN
Other
Enumeration date
02/23/2007
Last updated
07/08/2007
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