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General NPI Number Information
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NPI Number | 1538535331
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Entity Type | Organization
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Legal Business Name | NICHOLAS A MEDEL DDS PC
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Dates
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Enumeration Date | 08/15/2015
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Last Update Date | 08/15/2015
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Provider Practice Location Address
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Address Line | 307 E CLINTON AVE
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City | ATHENS
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State | TX
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Zip | 75751-3405
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Country | US
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Telephone | 586-291-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 307 E CLINTON AVE
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City | ATHENS
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State | TX
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Zip | 75751-3405
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Country | US
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Telephone | 586-291-2078
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS ADAM MEDEL
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Credential | DDS/OMS
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Telephone | 586-291-2078
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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 | 24965
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License Number State | TX
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