Organization Active NPI

Steven E. Nicholson, D.M.D., P.C.

  • General Practice Dentistry
  • Hazleton, PA
National Provider Identifier
1164054565
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
STEVEN E. NICHOLSON, D.M.D., P.C.
Practice address
14 S Cedar St
Hazleton, PA 18201-6602
Phone
(570) 455-6275
NPI assigned
Feb 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Authorized official

Name
Dr. Steven Earl Nicholson, DMDNPI 1881794386
Title
President
Phone
(570) 455-6275

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

14 S Cedar St
Hazleton, PA 18201-6602

Mailing address

14 S Cedar St
Hazleton, PA 18201-6602
Phone (570) 455-6275

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200416000349 PA Part B Supplier - Clinic/Group Practice 3678903549 Receives reassigned benefits from 1 practitioner
Practice locations: Hazleton, PA

National Provider Directory

National Provider Directory

Locations

14 S Cedar St
Hazleton, PA 18201
Phone (570) 455-6275

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1580774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1164054565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 S CEDAR ST",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182016602",
            "telephone_number": "570-455-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 S CEDAR ST",
            "city": "HAZLETON",
            "state": "PA",
            "postal_code": "182016602",
            "telephone_number": "570-455-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVEN E. NICHOLSON, D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-04",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-455-6275",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazleton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.