Nicholas DO

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17855 Issued in MD

Practice address

1286 Maryland RT 3 S
Crofton, MD 21114-1339

Phone

(410) 721-8200

NPI assigned

Apr 1, 2022

Last updated

Jun 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ulery Dental and Orthodontics

  • Dentist
  • Crofton, MD
  • NPI 1124081872
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1205576568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12809 PILOTS LANDING WAY",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208786118",
            "telephone_number": "240-744-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1286 MARYLAND RT 3 S",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211141339",
            "telephone_number": "410-721-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "NICHOLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-01",
        "last_updated": "2023-06-27",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "17855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherri Lynn Dibattista, MA
• Matthew E Dickson, PSYD
• Samantha Marie Dimattei
• District Therapy
• District Therapy
• Maria Doakes, BEHAVIOR TECHNICIAN
• Doctors First Professional Corporation
• Daniil Afanasyevich Dolya
• Andrew Joseph Doyle, OD
• Nghi Nina Nguyen Phuong Doyle, O.D.

• General Practice Dentistry in Crofton, MD
• Providers in Crofton, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.