Individual
DR. GARY S. NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2833 LINCOLN ST, SUITE 1, HIGHLAND, IN 46322-1924
(219) 838-2007
(219) 972-6267
Mailing address
8330 W 145TH PL, ORLAND PARK, IL 60462-2867
(708) 349-8677
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12009939A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130765
UNITED CONCORDIA
IN
01
—
755187
UNITED CONCORDIA
IN
Enumeration date
07/13/2006
Last updated
07/09/2007
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