Individual
DR. DALE CHARLES NICKELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
860 SUMMIT ST, STE 246, ELGIN, IL 60120-5145
(847) 695-1693
(847) 695-9212
Mailing address
860 SUMMIT ST, STE 246, ELGIN, IL 60120-5145
(847) 695-1693
(847) 695-9212
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
019-012082
IL
Other
Enumeration date
08/30/2010
Last updated
08/30/2010
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