Provider Demographics
NPI:1639189764
Name:JOEL I NATHANSON DMD MAGD PA
Entity Type:Organization
Organization Name:JOEL I NATHANSON DMD MAGD PA
Other - Org Name:NATHANSON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:NATHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MAGD
Authorized Official - Phone:410-891-8547
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD92671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty