Active NPI
Nicklaus Heath, D.D.S
- Dentist
- Crestview, FL
National Provider Identifier
1609259696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22161
- Practice address
- 2670 S Ferdon Blvd
Crestview, FL 32536-5480 - Phone
- (850) 634-0748
- NPI assigned
- Jul 8, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 22161 | FL | Primary |
Addresses
Primary practice location
2670 S Ferdon Blvd
Crestview, FL 32536-5480
Mailing address
1721 N 20TH Ave
Pensacola, FL 32503-5758
Phone (850) 384-8798
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160929002765 | FL | Order and Referring Only - Dentist | 7315234689 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22161 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483401600000",
"number": "1609259696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1721 N 20TH AVE",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325035758",
"telephone_number": "850-384-8798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2670 S FERDON BLVD",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325365480",
"telephone_number": "850-634-0748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEATH",
"first_name": "NICKLAUS",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-07-08",
"last_updated": "2017-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "22161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
- Patricia Haun, RDH
- Healing Hoof Steps Corporation
- Healinic Physical Therapy LLC
- Healthy Living Chiropractic Center
- Healthy Perspectives Counseling Group
- Delvin Mario Hector, LISW
- Andrea Renea Hefner, DNP, APRN, FNP-BC
- Steven Douglas Heinicke, DMD
- Lloyd Cole Heisler, D.C.
- Helen a Preston MD PA (Comprehensive Heart and Sleep)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2017; 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.