Active NPI
Richard Dale Nichols, DDS
- Dentist
- Mansfield, OH
National Provider Identifier
1629184791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30014979
- Practice address
- 552 S Trimble Rd
Mansfield, OH 44906-3418 - Phone
- (419) 756-0188
- Fax
- (419) 774-9671
- NPI assigned
- Aug 22, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30014979 | OH | Primary |
Addresses
Primary practice location
552 S Trimble Rd
Mansfield, OH 44906-3418
Mailing address
1674 Pin Oak Trail
Mansfield, OH 44906-3652
Phone (419) 774-0414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30014979 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248998400000",
"number": "1629184791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1674 PIN OAK TRAIL",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449063652",
"telephone_number": "419-774-0414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "552 S TRIMBLE RD",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449063418",
"telephone_number": "419-756-0188",
"fax_number": "419-774-9671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "RICHARD",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2009-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30014979",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.