Ian Alexander Niccum, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6000061-15 Issued in WI

Practice address

W6261 Neubert Rd
Appleton, WI 54913

Phone

(920) 954-1110

NPI assigned

Jul 26, 2022

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744588800000",
    "number": "1497481063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W7030 BLUEBLUFF WAY",
            "city": "GREENVILLE",
            "state": "WI",
            "postal_code": "549429783",
            "telephone_number": "217-722-1737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W6261 NEUBERT RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54913",
            "telephone_number": "920-954-1110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N1734 Lily Of The Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "WI",
            "postal_code": "549429044",
            "country_code": "US",
            "telephone_number": "920-289-2440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICCUM",
        "first_name": "IAN",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-26",
        "last_updated": "2025-04-14",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6000061-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Appleton, WI
• Providers in Appleton, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.

Verify at the official NPI Registry.