Provider Demographics
NPI:1376973693
Name:BISIG, NICOLAS RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:RYAN
Last Name:BISIG
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 1:3399 FLORENCE WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-2944
Mailing Address - Country:US
Mailing Address - Phone:706-255-3667
Mailing Address - Fax:
Practice Address - Street 1:125 COOL SPRINGS BLVD STE 140
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6475
Practice Address - Country:US
Practice Address - Phone:615-771-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9780122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist