Healthcare Provider Details

I. General information

NPI: 1699853960
Provider Name (Legal Business Name): THOMAS M NUSSEAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SOUTH MAIN STREET
SMITHSBURG MD
21783
US

IV. Provider business mailing address

PO BOX 246 40 SOUTH MAIN STREET
SMITHSBURG MD
21783
US

V. Phone/Fax

Practice location:
  • Phone: 301-824-2080
  • Fax: 301-824-4252
Mailing address:
  • Phone: 301-824-2080
  • Fax: 301-824-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12633MD
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS03144PA
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: