Jack E. Nicewander, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12007501A Issued in IN

Practice address

5511 E 82ND St
Suite F
Indianapolis, IN 46250-4698

Phone

(317) 842-1903

Fax

(317) 849-8054

NPI assigned

Nov 14, 2006

Sex

Male

Sole proprietor

Yes

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

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Indy Center for Sleep Health LLC

  • Customized Equipment (DME)
  • Fishers, IN
  • NPI 1194295600
  NPD (past) Authorized official
• Jack E Nicewander

  • Dental Clinic/Center
  • Indianapolis, IN
  • NPI 1689067928
  Authorized official Same address or phone

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659443802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5511 E 82ND ST",
            "address_2": "SUITE F",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462504698",
            "telephone_number": "317-842-1903",
            "fax_number": "317-849-8054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5511 E 82ND ST",
            "address_2": "SUITE F",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462504698",
            "telephone_number": "317-842-1903",
            "fax_number": "317-849-8054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICEWANDER",
        "first_name": "JACK",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007501A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yi Wen Ni
• Ryaan Niazi
• Melissa Hope Nice, NP
• Alexa Gabrielle Niceley, DO
• Kelly Nicely
• Kellie Nichelson
• Nicholas Catton DDS LLC
• Nicholas F Hrisomalos MD PC
• Bryn Katherine Nicholas, BCABA
• Karen Nicholas

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.