Individual
DR. JASON DANIEL NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2401 NW 23RD ST, SUITE 23, OKLAHOMA CITY, OK 73107-2442
(405) 942-0337
Mailing address
1355 N UNIVERSITY AVE SUITE #110, PROVO, UT 84604
(385) 309-0309
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
9410532-9923
UT
Other
Enumeration date
06/18/2010
Last updated
01/22/2016
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