Nicholas D Doll, D.M.D.
Individual provider Active NPI Dentist · Macomb, IL
NPI 1306250147 · NPPES record last updated Jun 19, 2014
Key facts
- NPI
- 1306250147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.029801 (IL)
- Practice address
- 1400 E Carroll St
Suite B
Macomb, IL 61455-1801 - Phone
- (309) 421-3163
- NPI assigned
- Jun 19, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160429000543 | IL | Order and Referring Only - Dentist |
2668771486 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.029801 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.029801 | IL | Yes |
Addresses
Primary practice location
1400 E Carroll St
Suite B
Macomb, IL 61455-1801
Mailing address
1400 E Carroll St
Suite B
Macomb, IL 61455-1801
Phone (309) 421-3163
Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.