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General NPI Number Information
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NPI Number | 1437312881
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Entity Type | Individual
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Provider Name | JEAN-LUC GASTON NIEL DMD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 5140 DORSEY HALL DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-7897
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Country | US
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Telephone | 410-997-5826
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Fax | 410-997-3200
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Provider Business Mailing Address
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Address Line | 662 GATESTONE ST
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City | GAITHERSBURG
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State | MD
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Zip | 20878-2100
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Country | US
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Telephone | 707-689-8461
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 15800
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License Number State | MD
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