Individual
DR. JACK E. NICEWANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5511 E 82ND ST, SUITE F, INDIANAPOLIS, IN 46250-4698
(317) 842-1903
(317) 849-8054
Mailing address
5511 E 82ND ST, SUITE F, INDIANAPOLIS, IN 46250-4698
(317) 842-1903
(317) 849-8054
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007501A
IN
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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