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General NPI Number Information
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NPI Number | 1104386556
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Entity Type | Individual
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Provider Name | NICOLE AGNERIS ESQUILIN
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Gender | Female
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 2700 LIGHTHOUSE PT E STE 210
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City | BALTIMORE
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State | MD
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Zip | 21224-4773
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Country | US
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Telephone | 410-675-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 103 E MOUNT ROYAL AVE APT 905
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City | BALTIMORE
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State | MD
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Zip | 21202-8114
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Country | US
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Telephone | 787-379-7983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17100
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License Number State | MD
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