NPIMap

Individual provider Active NPI

David Nill

  • Dentist
  • Fairfield, CT
National Provider Identifier
1083957237
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11188 Issued in CT
Practice address
320 Post Road
Fairfield, CT 06824
Phone
(203) 254-3780
NPI assigned
Apr 5, 2013
Last updated
Jul 9, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 11188 CT Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

320 Post Road
Fairfield, CT 06824

Mailing address

76 Elm St
Ansonia, CT 06401-3310
Phone (978) 273-0154

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11188CTMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Forella and Donahue Dentistry LLC PastSince Feb 6, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1365120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404864000000",
    "number": "1083957237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 ELM ST",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "064013310",
            "telephone_number": "978-273-0154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 POST ROAD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06824",
            "telephone_number": "203-254-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILL",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-05",
        "last_updated": "2014-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "11188",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.