Individual
JACY ADAM NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
630 KIMMELL RD, SUITE C, VINCENNES, IN 47591-6330
(812) 316-2013
Mailing address
3676 W 200S, JASPER, IN 47546-8200
(812) 661-0024
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011947A
IN
Other
Enumeration date
05/22/2013
Last updated
05/22/2013
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