Provider Demographics
NPI:1114141728
Name:NICOLA, AMIE K (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:K
Last Name:NICOLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BEARBERRY RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2049
Mailing Address - Country:US
Mailing Address - Phone:607-382-7146
Mailing Address - Fax:
Practice Address - Street 1:14203 COASTAL HWY STE 1
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-7414
Practice Address - Country:US
Practice Address - Phone:410-250-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0495581223G0001X
MD153831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice