Nicole Nothongkham, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D14748 Issued in MN

Practice address

4803 Miller Trunk Hwy Ste B
Hermantown, MN 55811-4804

Phone

(218) 722-7770

NPI assigned

Jun 7, 2022

Last updated

Jun 7, 2022By the provider in NPPES

Sex

Female

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

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.

• Bluestone Dental PLLC

  • General Practice Dentistry
  • Duluth, MN
  • NPI 1801260187
  NPD (past)
• PDG, PA

  dba Park Dental BlueStone

  • Dental Clinic/Center
  • Duluth, MN
  • NPI 1144780420
  NPD (past)

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1679202485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 82ND AVE N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554441573",
            "telephone_number": "763-229-7577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4803 MILLER TRUNK HWY STE B",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558114804",
            "telephone_number": "218-722-7770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "906 Woodland Ave",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558121113",
            "country_code": "US",
            "telephone_number": "218-606-1040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOTHONGKHAM",
        "first_name": "NICOLE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New Leaf Psychotherapy and Consulting (New Leaf Counseling)
• Gunnar Thomas Nollet
• Bria Elise Norlen
• Northern Refractive Surgery Center LTD (Northern Eye Institute)
• Northern Waters Clinic
• Matthew O'Connor
• Mara Beth Olinger, PA-C
• Anthony W Olson
• Brenda Lynn Olson
• Jeffrey L Olson, PSYD LP

• Dentist in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; 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.