Provider Demographics
NPI:1073801932
Name:HENRY-TOMCZUK, NICOLA (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:HENRY-TOMCZUK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NICOLA
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7450 ALBERT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3035
Mailing Address - Country:US
Mailing Address - Phone:301-836-9645
Mailing Address - Fax:301-597-9034
Practice Address - Street 1:7450 ALBERT RD FL 1
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3035
Practice Address - Country:US
Practice Address - Phone:301-836-9645
Practice Address - Fax:301-597-9034
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100915000Medicaid