Provider Demographics
NPI:1962423434
Name:NICHOLS, RUSSELL J II (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:J
Last Name:NICHOLS
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 JEFFREY ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4327
Mailing Address - Country:US
Mailing Address - Phone:319-338-3391
Mailing Address - Fax:
Practice Address - Street 1:501 S WHITE ST
Practice Address - Street 2:STE. #25
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2600
Practice Address - Country:US
Practice Address - Phone:319-385-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA6627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist