Individual provider Active NPI

Michael J Nies

  • General Practice Dentistry
  • Smyrna, DE
National Provider Identifier
1568629277
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
G1-0001264 Issued in DE
Practice address
27 Deak Dr
Smyrna, DE 19977-1268
Phone
(302) 653-6661
Fax
(302) 653-0661
NPI assigned
May 20, 2008
Last updated
Aug 3, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12011123A IN
General Practice Dentistry 1223G0001X G1-0001264 DE Primary

Addresses

Primary practice location

27 Deak Dr
Smyrna, DE 19977-1268

Mailing address

27 Deak Dr
Smyrna, DE 19977-1268
Phone (302) 653-6661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150605001141 DE Order and Referring Only - DentistPractitioner - Dentist 4587985221

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
G1-0001264DEMDGeneral Practice Dentistry
12011123AINMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Deakyne, Dental Associates, P.a. General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280793600000",
    "number": "1568629277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 DEAK DR",
            "city": "SMYRNA",
            "state": "DE",
            "postal_code": "199771268",
            "telephone_number": "302-653-6661",
            "fax_number": "302-653-0661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 DEAK DR",
            "city": "SMYRNA",
            "state": "DE",
            "postal_code": "199771268",
            "telephone_number": "302-653-6661",
            "fax_number": "302-653-0661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIES",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-20",
        "last_updated": "2010-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011123A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "G1-0001264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, DE

Sources for this page

Verify at the official NPI Registry.