Individual
KYLE NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
201 S MARKET ST, OTTUMWA, IA 52501-2924
(641) 683-5773
Mailing address
PO BOX 458, OTTUMWA, IA 52501-0458
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
09669
IA
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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