Active NPI
Tim P Nicolino, D.D.S.
- General Practice Dentistry
- Des Moines, IA
National Provider Identifier
1104907385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6914
- Practice address
- 1004 E Park Ave
Des Moines, IA 50315-2451 - Phone
- (515) 244-7428
- Fax
- (515) 244-2437
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6914 | IA | Primary |
Addresses
Primary practice location
1004 E Park Ave
Des Moines, IA 50315-2451
Mailing address
1004 E. Park Ave
Des Moines, IA 50315
Phone (515) 244-7428
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6914 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104907385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1004 E. PARK AVE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "50315",
"telephone_number": "515-244-7428",
"fax_number": "515-244-2437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1004 E PARK AVE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503152451",
"telephone_number": "515-244-7428",
"fax_number": "515-244-2437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICOLINO",
"first_name": "TIM",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "6914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.