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General NPI Number Information
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NPI Number | 1184479115
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Entity Type | Organization
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Legal Business Name | NICHOLSON ENDODONTICS LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 995 PRINCE FREDERICK BLVD STE 107
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-3199
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Country | US
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Telephone | 443-684-2016
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 349
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City | GALESVILLE
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State | MD
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Zip | 20765-0349
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Country | US
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Telephone | 304-290-4644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATHANIEL THORBURN NICHOLSON
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Credential | DDS, MS
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Telephone | 443-684-2016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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