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General NPI Number Information
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NPI Number | 1275421166
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Entity Type | Individual
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Provider Name | NICHOLAS DEGRACIA HIPOLITO
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Gender | Male
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 405 FREDERICK RD STE 108
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City | CATONSVILLE
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State | MD
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Zip | 21228-4646
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Country | US
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Telephone | 410-747-7498
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Fax |
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Provider Business Mailing Address
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Address Line | 10700 CARDINGTON WAY APT 103
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-3145
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Country | US
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Telephone |
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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 | 18835
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License Number State | MD
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