Provider Demographics
NPI:1245240340
Name:NATHANSON, JOEL I (DMD MAGD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:I
Last Name:NATHANSON
Suffix:
Gender:M
Credentials:DMD MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SHAWAN RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1373
Mailing Address - Country:US
Mailing Address - Phone:410-891-8547
Mailing Address - Fax:
Practice Address - Street 1:5 SHAWAN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1373
Practice Address - Country:US
Practice Address - Phone:410-891-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD92671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice