Individual
BRIAN SCOTT NICOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
214 LARKIN ST, TOMAH, WI 54660-0606
(608) 372-3298
(608) 372-3128
Mailing address
PO BOX 606, 214 LARKIN ST, TOMAH, WI 54660-0606
(608) 372-3298
(608) 372-3128
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001183
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33563100
—
WI
Enumeration date
08/21/2006
Last updated
12/06/2021
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