| James A Nicholson Dds Pa | |
|
120 South 28th Avenue Hattiesburg MS 39465 | |
| (601) 268-1111 | |
| (601) 268-2888 |
| Full Name | James A Nicholson Dds Pa |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 120 South 28th Avenue, Hattiesburg, Mississippi |
| Authorized Official Name and Position | James A Nicholson (ORTHODONTIST) |
| Authorized Official Contact | 6012681111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| James A Nicholson Dds Pa 120 South 28th Avenue Hattiesburg MS 39465 Ph: (601) 268-1111 | James A Nicholson Dds Pa 120 South 28th Avenue Hattiesburg MS 39465 Ph: (601) 268-1111 |
| NPI Number | 1750596938 |
|---|---|
| Provider Enumeration Date | 05/11/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750596938 | NPI | - | NPPES |
| 04682721 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 194181 (Mississippi) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 6863 (Mississippi) | Primary |
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