Provider Demographics
NPI:1184479115
Name:NICHOLSON ENDODONTICS LLC
Entity type:Organization
Organization Name:NICHOLSON ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:THORBURN
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:443-684-2016
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:GALESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20765-0349
Mailing Address - Country:US
Mailing Address - Phone:304-290-4644
Mailing Address - Fax:
Practice Address - Street 1:995 PRINCE FREDERICK BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3199
Practice Address - Country:US
Practice Address - Phone:443-684-2016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental