MEDICARE: MARC GORDON NUGER DDS

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	6975	MD

General Provider Information

NPI Number	:	1619142726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC GORDON NUGER DDS

Provider Business Mailing Address
First Line	:	7836 OAKWOOD RD STE B
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4298
Country	:	US
Telephone Number	:	410-766-4650
Fax Number	:	410-787-1133

Provider Business Practice Location Address
First Line	:	7836 OAKWOOD RD STE B
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4298
Country	:	US
Telephone Number	:	410-766-4650
Fax Number	:	410-787-1133

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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