Individual
DR. IAN ALEXANDER NICCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
W6261 NEUBERT RD, APPLETON, WI 54913
(920) 954-1110
Mailing address
W7030 BLUEBLUFF WAY, GREENVILLE, WI 54942-9783
(217) 722-1737
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6000061-15
WI
Other
Enumeration date
07/26/2022
Last updated
04/14/2025
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