Provider Demographics
NPI:1417182916
Name:NICHOLSON, NATHANIEL T (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:T
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 RITCHIE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3941
Mailing Address - Country:US
Mailing Address - Phone:410-647-3453
Mailing Address - Fax:410-647-3454
Practice Address - Street 1:8221 RITCHIE HWY STE 201
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-3941
Practice Address - Country:US
Practice Address - Phone:410-647-3453
Practice Address - Fax:410-647-3454
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38601223G0001X
MD153921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice