Organization
PERIODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ROBERT NITZELL DDS (PRESIDENT PERIODONTIST)
(301) 797-7410
Entity
Organization
Contact information
Practice address
19816 LEITERSBURG PIKE, HAGERSTOWN, MD 21742-1444
(301) 797-7410
(301) 797-7412
Mailing address
19816 LEITERSBURG PIKE, HAGERSTOWN, MD 21742-1444
(301) 797-7410
(301) 797-7412
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
10/17/2007
Last updated
10/17/2007
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