Individual
DR. JEFFREY NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4413 SE 39TH AVE, PORTLAND, OR 97202-3117
(503) 777-2284
Mailing address
4413 SE 39TH AVE, PORTLAND, OR 97202-3117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6372
OR
Other
Enumeration date
06/06/2006
Last updated
05/09/2008
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