Nina Victores, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

37579 Issued in TX

Practice address

2965 Harrison St Ste 210
Beaumont, TX 77702-1149

Phone

(409) 363-5027

NPI assigned

Aug 16, 2021

Sex

Female

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

Opted out of Medicare

Yes, effective Jan 3, 2023 through Jan 3, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• College Station Modern Dentistry PC

  • Dentist
  • College Station, TX
  • NPI 1124420781
  NPD (past)

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

{
    "created_epoch": "1629072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1376218818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2370 WELLINGTON PL",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777063388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2965 HARRISON ST STE 210",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021149",
            "telephone_number": "409-363-5027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTORES",
        "first_name": "NINA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-16",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "37579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joselito Vicente, P.T.
• Marion Marold Vickerman, MS, LMFT
• Denise Darlene Vickers, SA-C/CST
• Christopher Vickery, NP
• Andrew Victores, M.D.
• Ruben D Victores, MD
• Victory Medical Center Beaumont, L.P.
• Vida Keller Riston RN CNM PC
• Sheila Vidal, RPH
• Vidor Texas Care LLC

• General Practice Dentistry in Beaumont, TX
• Providers in Beaumont, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.