MEDICARE: DR. NATHANIEL T NICHOLSON D.D.S., M.S.

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	1223G0001X	General Practice Dentistry	3860	WV
2	1223E0200X	Endodontics	15392	MD

General Provider Information

NPI Number	:	1417182916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHANIEL T NICHOLSON D.D.S., M.S.

Provider Business Mailing Address
First Line	:	8221 RITCHIE HWY STE 201
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-3941
Country	:	US
Telephone Number	:	410-647-3453
Fax Number	:	410-647-3454

Provider Business Practice Location Address
First Line	:	8221 RITCHIE HWY STE 201
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-3941
Country	:	US
Telephone Number	:	410-647-3453
Fax Number	:	410-647-3454

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	11/07/2021

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