Individual
DR. RICHARD SCOT NICKLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
497 SOUTH WALL ST, KANKAKEE, IL 60901
(815) 932-6251
Mailing address
497 SOUTH WALL ST, KANKAKEE, IL 60901
(815) 932-6251
(815) 932-2132
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Enumeration date
12/14/2006
Last updated
07/08/2007
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