Jacob Nichols, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN4802 Issued in ME

Practice address

163 Pleasant Ave
Portland, ME 04103-3242

Phone

(207) 771-2093

NPI assigned

Jun 22, 2020

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Deering Center Dental LLC

  • General Practice Dentistry
  • Portland, ME
  • NPI 1245947092
  NPD Authorized official

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1013533496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 BUCA RUN",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031478",
            "telephone_number": "207-408-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 PLEASANT AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041033242",
            "telephone_number": "207-771-2093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DEN4802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAINE DENTAL LICENSE",
            "identifier": "DEN4802",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackie K Nguyen, MD
• Janie Dao Nguyen, D.O.
• Sonka T Nguyen
• Lori Nicholas, PMHNP-BC
• Samantha Nicholas, RN
• Jonathan Michael Nichols, D.O.
• Kelly M Nichols, MD
• Kelsey Nichols, LCSW
• Lynne Nichols, NP
• Miranda Nichols

• General Practice Dentistry in Portland, ME
• Providers in Portland, ME by specialty
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; 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.