Samuel McNickle, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN.00202859 Issued in CO

Practice address

6140 Tutt Blvd Ste 150
Colorado Springs, CO 80923-3574

Phone

(719) 622-9200

NPI assigned

Jun 15, 2016

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": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465948800000",
    "number": "1588014187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 TUTT BLVD STE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809233574",
            "telephone_number": "719-622-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 TUTT BLVD STE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809233574",
            "telephone_number": "719-622-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNICKLE",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00202859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth McNeeley
• Samantha Jean McNeely
• Maria McNeill
• Octavia McNeill, RBT
• Sean McNeill
• Caroline McNiece, PSYCHOTHERAPIST
• Shannon McNiece, LPC
• Faith Leanne McNitt, BSW
• Christopher Robert McNulty, D.O.
• Colton McNutt, PSYD

• General Practice Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.