Samuel Bahram Nicholson, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30.027648 Issued in OH

Practice address

111 Michigan Ave NW
Washington, DC 20010-2916

Phone

(202) 476-5000

NPI assigned

May 9, 2022

Last updated

Dec 3, 2024By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1652054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1659017051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 JUNCTION WAY APT 419",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432122575",
            "telephone_number": "740-644-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MICHIGAN AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200102916",
            "telephone_number": "202-476-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "SAMUEL",
        "middle_name": "BAHRAM",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-09",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30.027648",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Ryles Nicholson, MD
• McArthur Nicholson
• Mickaela Nicholson, PH.D.
• Nakia Nicholson
• Princess Ann Nicholson
• Shayla Yvette Nicholson, PCA
• Steven Lyle Nicholson, LCSW, LICSW
• Nick & Frank Stein
• April Nickens
• David Daryl Nickens, LPC

• Pediatric Dentistry in Washington, DC
• Providers in Washington, DC by specialty
• Pediatric Dentistry in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.