Provider Demographics
NPI:1053418400
Name:NICHOLS-JOHNSON, HEIDI M (DDS)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:NICHOLS-JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 N. WASHINGTON ST.
Mailing Address - Street 2:PO BOX 7039
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58507-7039
Mailing Address - Country:US
Mailing Address - Phone:701-258-7900
Mailing Address - Fax:701-250-0557
Practice Address - Street 1:1929 N. WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58507-7039
Practice Address - Country:US
Practice Address - Phone:701-258-7900
Practice Address - Fax:701-250-0557
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice