Active NPI
Kongyan Drew Nicely, DDS
- Dentist
- Goliad, TX
National Provider Identifier
1194177337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31979
- Practice address
- 317 S Market St
Goliad, TX 77963-4167 - Phone
- (361) 645-2381
- NPI assigned
- Jul 12, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 31979 | TX | Primary |
Addresses
Primary practice location
317 S Market St
Goliad, TX 77963-4167
Mailing address
317 S Market St
P.O. Box 1480
Goliad, TX 77963-4167
Phone (361) 645-2381
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 |
|---|---|---|---|
| 31979 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amdg Dental PLLC | Past | Accepting new patients | |
| Goliad Dental Care | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dental Clinic/Center
- Goliad, TX
- NPI 1376283010
-
- General Practice Dentistry
- Goliad, TX
- NPI 1003924267
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468281600000",
"number": "1194177337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 S MARKET ST",
"address_2": "P.O. BOX 1480",
"city": "GOLIAD",
"state": "TX",
"postal_code": "779634167",
"telephone_number": "361-645-2381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 S MARKET ST",
"city": "GOLIAD",
"state": "TX",
"postal_code": "779634167",
"telephone_number": "361-645-2381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICELY",
"first_name": "KONGYAN",
"middle_name": "DREW",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-12",
"last_updated": "2016-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "31979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goliad, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.