Individual provider Active NPI

Nikole Novikova

  • Dentist
  • Scottsdale, AZ
National Provider Identifier
1225440662
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D011130 Issued in AZ
Practice address
10005 E Osborn Rd BLDG 61
Scottsdale, AZ 85256-4019
Phone
(480) 946-9066
NPI assigned
May 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X CG60460804 WA
Dentist 122300000X D011130 AZ Primary

Addresses

Primary practice location

10005 E Osborn Rd BLDG 61
Scottsdale, AZ 85256-4019

Mailing address

4628 S Centric Way
Mesa, AZ 85212-9417

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, ME2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221221003001 TX Practitioner - Dentist 2062818933 Reassigns benefits to 1 organization
I20240430003894 ME Practitioner - Dentist 2062818933 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CG60460804WAMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Salt River Pima-Maricopa Indian Community CurrentSince Sep 10, 2022 Accepting new patients
Harrington Family Health Center CurrentSince Apr 8, 2024 Accepting new patients
Salt River Pima-Maricopa Indian Community CurrentSince Sep 10, 2022 Accepting new patients
Passamaquoddy Tribal Council Past Accepting new patients
Salt River Pima-Maricopa Indian Community PastSince Aug 29, 2021 Accepting new patients
Cbpi, LLC Behavior Analyst Past Accepting new patients

Locations

10005 E Osborn Rd
Bldg 61
Scottsdale, AZ 85256
Phone (480) 946-9103

10901 E McDowell Rd
Scottsdale, AZ 85256
Phone (480) 278-7742

50 E Main St
Harrington, ME 04643

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10564/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629849600000",
    "number": "1225440662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4628 S CENTRIC WAY",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852129417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10005 E OSBORN RD BLDG 61",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852564019",
            "telephone_number": "480-946-9066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVIKOVA",
        "first_name": "NIKOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-20",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WA",
            "license": "CG60460804",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D011130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

Verify at the official NPI Registry.