Provider Demographics
NPI:1669639209
Name:NIEMANN, RALPH WALTER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WALTER
Last Name:NIEMANN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3144
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-2505
Mailing Address - Fax:410-535-2510
Practice Address - Street 1:272 MERRIMAC COURT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-2505
Practice Address - Fax:410-535-2510
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107881223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics