Provider Demographics
NPI:1093060410
Name:RESSEL, NICHOLAS GEORGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:RESSEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5127 SHOAL LINE BLVD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2715
Mailing Address - Country:US
Mailing Address - Phone:352-596-2604
Mailing Address - Fax:
Practice Address - Street 1:674 BOULEVARD DE FRANCE,
Practice Address - Street 2:
Practice Address - City:PARRIS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29905
Practice Address - Country:US
Practice Address - Phone:843-228-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 19868122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist