Provider Demographics
NPI:1003832684
Name:DRS RUSSELL & NICHOLAS-HOLMES
Entity Type:Organization
Organization Name:DRS RUSSELL & NICHOLAS-HOLMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS-HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-566-4200
Mailing Address - Street 1:4714 EDMONDSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229
Mailing Address - Country:US
Mailing Address - Phone:410-566-4200
Mailing Address - Fax:410-566-1770
Practice Address - Street 1:4714 EDMONDSON AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229
Practice Address - Country:US
Practice Address - Phone:410-566-4200
Practice Address - Fax:410-566-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty