Provider Demographics
NPI:1225489610
Name:NATHAN D NITZ, DMD PLLC
Entity Type:Organization
Organization Name:NATHAN D NITZ, DMD PLLC
Other - Org Name:CAPITOL SMILES - NATHAN D NITZ, DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-223-3468
Mailing Address - Street 1:105 DIAGNOSTIC DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6559
Mailing Address - Country:US
Mailing Address - Phone:502-223-3468
Mailing Address - Fax:
Practice Address - Street 1:105 DIAGNOSTIC DR
Practice Address - Street 2:SUITE A
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6559
Practice Address - Country:US
Practice Address - Phone:502-223-3468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9470261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100400700Medicaid