MEDICARE: NICOLE AGNERIS ESQUILIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	17100	MD

General Provider Information

NPI Number	:	1104386556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE AGNERIS ESQUILIN

Provider Business Mailing Address
First Line	:	103 E MOUNT ROYAL AVE APT 905
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-8114
Country	:	US
Telephone Number	:	787-379-7983
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 LIGHTHOUSE PT E STE 210
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-4773
Country	:	US
Telephone Number	:	410-675-3300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	05/10/2021

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Directions to “ NICOLE AGNERIS ESQUILIN ” Practice Location

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