Individual
BRENT EUGENE NIKOLAUS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
81ST DS/SGD, 606 FISHER ST, BLDG 0824, KEESLER AFB, MS 39534-2567
(228) 377-5890
Mailing address
3810 POINT CLEAR DR, OCEAN SPRINGS, MS 39564-8193
(228) 818-9412
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS0000004593
TN
Other
Enumeration date
04/26/2006
Last updated
07/08/2007
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