Individual
WILLIAM GRANT NICKLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
301 OXFORD VALLEY RD, 301A, YARDLEY, PA 19067-7706
(215) 493-8485
Mailing address
301 OXFORD VALLEY RD, 301A, YARDLEY, PA 19067-7706
(215) 493-8485
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DS20762L
PA
Other
Enumeration date
06/22/2006
Last updated
10/16/2012
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