Provider Demographics
NPI:1770550121
Name:RICHARD J. NESSIF, D. D. S. , P. C.
Entity type:Organization
Organization Name:RICHARD J. NESSIF, D. D. S. , P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NESSIF
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:410-997-1010
Mailing Address - Street 1:10203 TANAGER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3904
Mailing Address - Country:US
Mailing Address - Phone:410-997-1010
Mailing Address - Fax:410-997-0807
Practice Address - Street 1:10203 TANAGER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3904
Practice Address - Country:US
Practice Address - Phone:410-997-1010
Practice Address - Fax:410-997-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4836OtherDENTAL
MD498501000Medicaid
MD498501000Medicaid