Brantley Paul Nichols, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3560-10 Issued in MS

Practice address

840 N Oak Ave
Ruleville, MS 38771-3227

Phone

(601) 624-8209

NPI assigned

Jul 14, 2008

Last updated

Aug 14, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Oral & Maxillofacial Surgery Clinic of South Misssissippi, P.a.

  dba Hattiesburg Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Hattiesburg, MS
  • NPI 1578596060
  NPD (past)
• South Mississippi Oral Surgery & Implant Center PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Gulfport, MS
  • NPI 1780466300
  NPD (past)

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1265696769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10270",
            "city": "GREENWOOD",
            "state": "MS",
            "postal_code": "389300270",
            "telephone_number": "601-624-8209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N OAK AVE",
            "city": "RULEVILLE",
            "state": "MS",
            "postal_code": "387713227",
            "telephone_number": "601-624-8209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "BRANTLEY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-14",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "8276",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MS",
            "license": "3560-10",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Lucas, PARAMEDIC
• Mississippi Commcare Corporation a Non Profit Corporation (Ruleville Community Care Center)
• Mississippi State Department of Health
• Cary H Moore
• Airston Small Moses, FNP
• North Sunflower Medical Center (NSMC Pro Fees)
• North Sunflower Medical Center (North Sunflower Medical Center - CRNA)
• North Sunflower Medical Center (Sunflower Rural Health Clinic)
• North Sunflower Medical Center
• North Sunflower Medical Center

• Oral and Maxillofacial Surgery (Dentist) in Ruleville, MS
• Providers in Ruleville, MS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.