Individual
SAMUEL BAHRAM NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
111 MICHIGAN AVE NW, WASHINGTON, DC 20010-2916
(202) 476-5000
Mailing address
825 JUNCTION WAY APT 419, COLUMBUS, OH 43212-2575
(740) 644-1230
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30.027648
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2022
Last updated
12/03/2024
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