Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 22DI023383000 | NJ |
Y | 1223P0300X | Periodontist | DS025369-L | PA |
NPI | 1154460608 |
---|---|
Provider Name | Dr. John R Nikas |
First Address | West Chester, PA 19380 |
Second Address | West Chester, PA 19380-3302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |