Active NPI
Jason Daniel Nicholson, D.D.S.
- Periodontics
- Oklahoma City, OK
National Provider Identifier
1598086001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 9410532-9923
- Practice address
- 2401 NW 23Rd St
Suite 23
Oklahoma City, OK 73107-2442 - Phone
- (405) 942-0337
- NPI assigned
- Jun 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 9410532-9923 | UT | Primary |
Addresses
Primary practice location
2401 NW 23Rd St
Suite 23
Oklahoma City, OK 73107-2442
Mailing address
1355 N University Ave Suite #110
Provo, UT 84604
Phone (385) 309-0309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453420800000",
"number": "1598086001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1355 N UNIVERSITY AVE SUITE #110",
"city": "PROVO",
"state": "UT",
"postal_code": "84604",
"telephone_number": "385-309-0309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 NW 23RD ST",
"address_2": "SUITE 23",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731072442",
"telephone_number": "405-942-0337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "JASON",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-18",
"last_updated": "2016-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "UT",
"license": "9410532-9923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.