| NPI | 1851464697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETE NICK NICKOLAS Doctor Of Dental Surgery General 410-848-9540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 5819) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 5922) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |