Provider Demographics
NPI:1346459278
Name:LIVINGSTON, NICHOLAS RYAN (DMD, MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RYAN
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8707
Mailing Address - Country:US
Mailing Address - Phone:205-208-0167
Mailing Address - Fax:800-244-8132
Practice Address - Street 1:420 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8707
Practice Address - Country:US
Practice Address - Phone:205-208-0167
Practice Address - Fax:800-244-8132
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL54711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program