MEDICARE: DR. JEAN-LUC GASTON NIEL DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	15800	MD

General Provider Information

NPI Number	:	1437312881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN-LUC GASTON NIEL DMD

Provider Business Mailing Address
First Line	:	662 GATESTONE ST
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-2100
Country	:	US
Telephone Number	:	707-689-8461
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 DORSEY HALL DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7897
Country	:	US
Telephone Number	:	410-997-5826
Fax Number	:	410-997-3200

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	03/20/2024

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