John R Nichols, DDS
Individual provider Active NPI Dentist · Munford, TN
NPI 1154499382 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154499382
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2396 (TN)
- Practice address
- 28 N Tipton
Munford, TN 38058 - Phone
- (901) 837-3455
- Fax
- (901) 837-3465
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150923002408 | TN | Order and Referring Only - Oral Surgery |
0244547297 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2396 | TN | MD | Obstetrics & Gynecology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2396 | TN | Yes |
Addresses
Primary practice location
28 N Tipton
Munford, TN 38058
Mailing address
PO Box 1377
Munford, TN 38058
Phone (901) 837-3455
Other providers in Munford, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.