Organization
DR. PATRICIA NICKLAS
Active
Other names
Nicklas Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICIA NICKLAS DDS (MEMBER/DENTIST)
(843) 412-4036
Entity
Organization
Contact information
Practice address
9565 HIGHWAY 78, UNIT 600B, LADSON, SC 29456-4118
(843) 412-4036
Mailing address
9565 HIGHWAY 78, UNIT 600B, LADSON, SC 29456-4118
(843) 412-4036
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4626
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023230414
—
SC
05
—
ZX4626
—
SC
Enumeration date
08/15/2013
Last updated
08/15/2013
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