Nicholas Fetters, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019.033086 Issued in IL

Practice address

480 Central Ave
Jbphh, HI 96860-4908

Phone

(808) 473-1880

NPI assigned

Jul 24, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1627084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724544000000",
    "number": "1225601438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1253 MAKALAPA GATE RD",
            "city": "JBPHH",
            "state": "HI",
            "postal_code": "968604479",
            "telephone_number": "808-473-1880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE",
            "city": "JBPHH",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-473-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTERS",
        "first_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-24",
        "last_updated": "2024-08-25",
        "certification_date": "2024-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.033086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel S Dutton, PH.D., M.P.
• Kendra Leanne Ekundayo, PHD, ABPP
• Nathan Stewart Ellis, MD
• James Caleb Ersando, ATP, NRP
• Nichole Fernandes, DENTAL HYGIENIST
• Andrew Fisher, MD
• Jason Francis Fisher, DO
• Michael Flores
• Charisma Q Foronda
• Brian Fulton

• Dentist in Jbphh, HI
• Providers in Jbphh, HI by specialty
• Dentist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.