MEDICARE: DR. NICHOLAS BRYCE NOTTAGE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14706	NC

General Provider Information

NPI Number	:	1508797085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS BRYCE NOTTAGE DDS

Provider Business Mailing Address
First Line	:	5682 GREEN DALE CT
Second Line	:
City	:	SUMMERFIELD
State	:	NC
Zip	:	27358-9156
Country	:	US
Telephone Number	:	336-580-0569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 HORSE PEN CREEK RD STE 105
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8392
Country	:	US
Telephone Number	:	336-855-3060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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