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General NPI Number Information
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NPI Number | 1801275052
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Entity Type | Organization
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Legal Business Name | NIU DENTISTRY, LLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 420 CRAIN HWY S STE 5
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3657
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Country | US
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Telephone | 410-766-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 THORNBROOK RD
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-7805
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Country | US
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Telephone | 410-916-4158
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KATELYN NIU
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Credential | DDS/PHD
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Telephone | 410-916-4158
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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 | 15421
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License Number State | MD
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