Healthcare Provider Details

I. General information

NPI: 1023454667
Provider Name (Legal Business Name): DMITRY NURMINSKY D.D.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 POINTER RIDGE PL SUITE K
BOWIE MD
20716-1875
US

IV. Provider business mailing address

1612 CHARMUTH RD ZDENTIST LLC
LUTHERVILLE MD
21093-5757
US

V. Phone/Fax

Practice location:
  • Phone: 301-249-9098
  • Fax:
Mailing address:
  • Phone: 508-904-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS039570
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15795
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: