Brock Wesley Nichols, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7763 Issued in OK

Practice address

3703 N Kickapoo Ave
Shawnee, OK 74804-1703

Phone

(405) 275-0640

Fax

(405) 225-3008

NPI assigned

Jul 16, 2021

Sex

Male

Sole proprietor

Yes

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

Practice roles

Locations

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.

• Brock Nichols DDS PLLC

  • Dental Clinic/Center
  • Midwest City, OK
  • NPI 1801783006
  NPD Authorized official
• Summer Dental Shawnee PLLC

  • Dentist
  • Shawnee, OK
  • NPI 1548834872
  NPD
• Doyel Maxus LLC

  • Dentist
  • Aloha, OR
  • NPI 1093187312
  NPD (past)

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

{
    "created_epoch": "1626393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1043882103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10041 OAKWOOD DR",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730255007",
            "telephone_number": "405-436-5583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3703 N KICKAPOO AVE",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041703",
            "telephone_number": "405-275-0640",
            "fax_number": "405-225-3008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "BROCK",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-16",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11449",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "7763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Newman
• Lauren Newman, LPC
• Martine Welehelale Ngamelue-Kouemo, ARNP
• Jordan Nguyen, DDS
• Kimberly Phan Nguyen
• Betty Jane Nicholson, LPN, RN
• Emily Brooke Nickerson, BA
• David Eugene Nicklas, DPH
• NKR Enterprises, Aprn-CNP, PLLC
• Jacob Nolen

• All providers in Shawnee, OK
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.