Healthcare Provider Details

I. General information

NPI: 1659062040
Provider Name (Legal Business Name): NICHOLAS NGUYEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LIGHT ST
BALTIMORE MD
21230-3856
US

IV. Provider business mailing address

600 LIGHT ST
BALTIMORE MD
21230-3856
US

V. Phone/Fax

Practice location:
  • Phone: 410-659-0900
  • Fax:
Mailing address:
  • Phone: 410-659-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18146
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: