NPI 1013533496

Jacob Nichols, DMD

Practitioner General Practice Dentistry Portland, ME

Practice location

Address: 163 Pleasant Ave, Portland, ME 04103-3242
Phone: (207) 771-2093
Mailing address: 27 Buca Run, Portland, ME 04103-1478

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence DEN4802 (ME)

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Registry record

NPI: 1013533496
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Jun 2020
Record last updated: 22 Jun 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.