Active NPI
Nikki Shakourian
- Orthodontics and Dentofacial Orthopedics Dentistry
- Dallas, TX
National Provider Identifier
1215276399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 29968
- Practice address
- 2011 W Bardin Road
Dallas, TX 76017-7596 - Phone
- (978) 852-9401
- NPI assigned
- Feb 8, 2013
- Last updated
- Aug 21, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901020868 | MI | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 29968 | TX | Primary |
Addresses
Primary practice location
2011 W Bardin Road
Dallas, TX 76017-7596
Mailing address
2011 W Bardin Rd
Arlington, TX 76017-1654
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170120002266 | TX | Order and Referring Only - Other (Physician) | 1355623638 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901020868 | MI | MD | Dentist |
| 29968 | TX | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lucent 410 Sa PLLC | Dentist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- San Antonio, TX
- NPI 1346120169
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408579200000",
"number": "1215276399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2011 W BARDIN RD",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760171654"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2011 W BARDIN ROAD",
"city": "DALLAS",
"state": "TX",
"postal_code": "760177596",
"telephone_number": "978-852-9401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAKOURIAN",
"first_name": "NIKKI",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-08",
"last_updated": "2014-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901020868",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TX",
"license": "29968",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; 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.