| Dr. Patricia Nicklas | |
|
9565 Highway 78 Unit 600b Ladson SC 29456-4118 | |
| (843) 412-4036 | |
| Not Available |
| Full Name | Dr. Patricia Nicklas |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9565 Highway 78, Ladson, South Carolina |
| Authorized Official Name and Position | Patricia Nicklas (MEMBER/DENTIST) |
| Authorized Official Contact | 8434124036 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Patricia Nicklas 9565 Highway 78 Unit 600b Ladson SC 29456-4118 Ph: (843) 412-4036 | Dr. Patricia Nicklas 9565 Highway 78 Unit 600b Ladson SC 29456-4118 Ph: (843) 412-4036 |
| NPI Number | 1558794396 |
|---|---|
| Provider Enumeration Date | 08/15/2013 |
| Last Update Date | 08/15/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558794396 | NPI | - | NPPES |
| 1023230414 | Medicaid | SC | |
| ZX4626 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4626 (South Carolina) | Primary |
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