Provider Demographics
NPI:1437312881
Name:NIEL, JEAN-LUC GASTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-LUC
Middle Name:GASTON
Last Name:NIEL
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 1:662 GATESTONE ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2100
Mailing Address - Country:US
Mailing Address - Phone:707-689-8461
Mailing Address - Fax:
Practice Address - Street 1:5140 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7897
Practice Address - Country:US
Practice Address - Phone:410-997-5826
Practice Address - Fax:410-997-3200
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery