Nicholas Broccoli, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401417373 Issued in VA

Practice address

3811 Westerre Pkwy
Ste a
Henrico, VA 23233-1329

Phone

(804) 354-1600

Fax

(804) 354-1607

NPI assigned

Mar 7, 2017

Last updated

Nov 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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.

Opted out of Medicare

Yes, effective Apr 1, 2024 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1235679432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71930",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232551930",
            "telephone_number": "804-354-1600",
            "fax_number": "804-354-1607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3811 WESTERRE PKWY",
            "address_2": "STE A",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232331329",
            "telephone_number": "804-354-1600",
            "fax_number": "804-354-1607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1807 Huguenot Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Midlothian",
            "state": "VA",
            "postal_code": "231135604",
            "country_code": "US",
            "telephone_number": "804-354-1600",
            "fax_number": "804-354-1607",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12220 Iron Bridge Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "VA",
            "postal_code": "238311543",
            "country_code": "US",
            "telephone_number": "804-354-1600",
            "fax_number": "804-354-1607",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8503 Patterson Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232296442",
            "country_code": "US",
            "telephone_number": "804-354-1600",
            "fax_number": "804-354-1607",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5942 Harbour Park Dr",
            "address_purpose": "LOCATION",
            "city": "Midlothian",
            "state": "VA",
            "postal_code": "231122163",
            "country_code": "US",
            "telephone_number": "804-354-1600",
            "fax_number": "804-354-1607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCCOLI",
        "first_name": "NICHOLAS",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-07",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401417373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylie Brincks
• Samuel Colt Brinkley, D.C.
• Ricardo Sierra Briones, RBT
• Casey Brizzolara
• Broad Smile Dentistry
• Jeffrey Brochetti, PHARMD
• Christina Marie Brockwell, AGACNP-BC
• Kathleen Julia Brogan, OTR/L
• Elvis F. Brooks Jr., LPC
• Ephesus Brooks

• Oral and Maxillofacial Surgery (Dentist) in Henrico, VA
• Providers in Henrico, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.