Individual
DR. JEREMY A NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
110 N CENTRAL AVE, SOMERSET, KY 42501
(606) 679-1402
Mailing address
117 CLAREMONT AVE, LOUISVILLE, KY 40206-2728
(160) 687-5113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10081
KY
Other
Enumeration date
04/04/2018
Last updated
05/17/2018
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