Active NPI
Nicole O'Pallick, DDS
- General Practice Dentistry
- Palmdale, CA
National Provider Identifier
1356727184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 64823
- Practice address
- 755 W Rancho Vista Blvd
Palmdale, CA 93551-3735 - Phone
- (661) 265-7800
- NPI assigned
- Aug 4, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 64823 | CA | Primary |
Addresses
Primary practice location
755 W Rancho Vista Blvd
Palmdale, CA 93551-3735
Mailing address
27140 Manor Cir
Valencia, CA 91354-2691
Phone (541) 971-3183
Other practice location 1
2323 E 4th St
Los Angeles, CA 90033-4305
Phone (323) 980-9090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356727184 | Medicaid | CA |
Other names 1
- Dr. Nicole Rose
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 |
|---|---|---|---|
| 64823 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Easley Dental Corporation | General Practice | Past | Accepting new patients |
| Christine Shahgaldian DDS Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Los Angeles, CA
- NPI 1972930873
-
dba Sierra Commons Dental Group
- General Practice Dentistry
- Palmdale, CA
- NPI 1669536678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438646400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551744000000",
"number": "1356727184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27140 MANOR CIR",
"city": "VALENCIA",
"state": "CA",
"postal_code": "913542691",
"telephone_number": "541-971-3183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 W RANCHO VISTA BLVD",
"city": "PALMDALE",
"state": "CA",
"postal_code": "935513735",
"telephone_number": "661-265-7800"
}
],
"practiceLocations": [
{
"address_1": "2323 E 4th St",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900334305",
"country_code": "US",
"telephone_number": "323-980-9090",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "O'PALLICK",
"first_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-04",
"last_updated": "2019-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "64823",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1356727184",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "ROSE",
"prefix": "DR.",
"credential": "DDS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Palmdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.