Individual
DR. KEITH NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
100 S BROAD ST STE 1530, PHILADELPHIA, PA 19110-1026
(267) 691-0606
Mailing address
UNIVERSITY OF LOUISVILLE, 501 SOUTH PRESTON ST., LOUISVILLE, KY 40292-0001
(502) 852-5124
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8644
NC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
12012234A
IN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
8644
NC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
8795/879
KY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS043962
PA
Other
Enumeration date
04/27/2009
Last updated
05/28/2023
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