Individual
TERESA ANN NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
200 E MCGALLIARD RD, MUNCIE, IN 47303-2009
(765) 254-1706
Mailing address
200 E MCGALLIARD RD, MUNCIE, IN 47303-2009
(765) 254-1706
(765) 254-1709
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010638A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200535070
—
IN
05
—
2618199
—
OH
Enumeration date
05/10/2006
Last updated
03/05/2013
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