Provider Demographics
NPI:1174324735
Name:DR. NICK WITHEM DENTAL PLLC
Entity type:Organization
Organization Name:DR. NICK WITHEM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WITHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-317-4612
Mailing Address - Street 1:126 HAWKS PERCH
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1184
Mailing Address - Country:US
Mailing Address - Phone:970-317-4612
Mailing Address - Fax:
Practice Address - Street 1:467 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540
Practice Address - Country:US
Practice Address - Phone:970-317-4612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental