Active NPI
Nicole Wax
- Oral and Maxillofacial Pathology Dentistry
- Linden, MI
National Provider Identifier
1285974097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Pathology Dentistry
- License
- 2901021150
- Practice address
- 120 N Bridge St Ste C
Linden, MI 48451-8823 - Phone
- (810) 458-6188
- NPI assigned
- Feb 15, 2013
- Last updated
- Jul 1, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Pathology Dentistry | 1223P0106X | 2901021150 | MI | Primary |
Addresses
Primary practice location
120 N Bridge St Ste C
Linden, MI 48451-8823
Mailing address
16215 Grand View Rd
Fenton, MI 48430-9194
Phone (810) 458-6188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901021150 | MI | MD | Oral and Maxillofacial Pathology Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751328000000",
"number": "1285974097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16215 GRAND VIEW RD",
"city": "FENTON",
"state": "MI",
"postal_code": "484309194",
"telephone_number": "810-458-6188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 N BRIDGE ST STE C",
"city": "LINDEN",
"state": "MI",
"postal_code": "484518823",
"telephone_number": "810-458-6188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAX",
"first_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-02-15",
"last_updated": "2025-07-01",
"certification_date": "2025-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0106X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Pathology",
"state": "MI",
"license": "2901021150",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Linden, MI
- Gregory Scott Thornhill
- Anna Tidwell, MASSAGE THERAPIST
- Total Wellness Chiropractic, Inc.
- Town Center Family Dental Linden PLLC (Town Center Family Dental Linden)
- Mark E Vogel, PHD
- Linda C Welch, PTA
- West Sky Wellness LLC
- Hannah Whitted Morgan Whitted
- Debra Marie Willing-Tucker, OTRL
- Wood Care X, Inc. (Caretel Inns of Linden)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.