Individual
NICHOLAS T NIKCHEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1100 N STATE ST RM A3C, LOS ANGELES, CA 90033-5000
(805) 728-5583
Mailing address
2753 WAVERLY DR APT 906, LOS ANGELES, CA 90039-2788
(805) 728-5583
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
105583
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/10/2020
Last updated
09/29/2020
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