Individual
DR. JOHN THOMAS NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
775 WAUKEGAN RD, SUITE 200, DEERFIELD, IL 60015-4342
(800) 317-0711
(800) 434-7113
Mailing address
403 CHERRYWOOD RD, LOUISVILLE, KY 40207-2101
(502) 897-7422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12009437A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200512620
—
IN
Enumeration date
01/17/2006
Last updated
05/09/2008
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