Nichole Lee Demars, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-025986 Issued in IL

Practice address

3976 Il Route 22 Ste E
Long Grove, IL 60047-5318

Phone

(847) 719-1973

Fax

(847) 719-1975

NPI assigned

Dec 20, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Nichole Demars Professional name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Long Grove Dental Studio

  • Dentist
  • Long Grove, IL
  • NPI 1568751436
  NPD (past) Authorized official

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

{
    "created_epoch": "1229731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1104062207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 W ROSCOE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186260",
            "telephone_number": "773-528-3384",
            "fax_number": "773-528-3604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3976 IL ROUTE 22 STE E",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600475318",
            "telephone_number": "847-719-1973",
            "fax_number": "847-719-1975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMARS",
        "first_name": "NICHOLE",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-20",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-025986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL INSURANCE CARRIERS",
            "identifier": "26-3663111",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICHOLE",
            "last_name": "DEMARS",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Angela Rose Depa
• Daniel R. Di Iorio, MD, DC
• Donna Digloria, APN
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• General Practice Dentistry in Long Grove, IL
• Providers in Long Grove, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.