NPIMap

Organization Active NPI

Jack E Nicewander

  • Dental Clinic/Center
  • Indianapolis, IN
National Provider Identifier
1689067928
Registry record updated Apr 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
12007501A Issued in IN
Legal business name
JACK E NICEWANDER
Practice address
5511 E 82ND St
Ste F
Indianapolis, IN 46250-4698
Phone
(317) 842-1903
Fax
(317) 849-8054
NPI assigned
Mar 11, 2015
Last updated
Apr 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jack E Nicewander, DDSNPI 1659443802
Title
Owner
Phone
(317) 842-1903

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 12007501A IN Primary

Addresses

Primary practice location

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

Mailing address

5511 E 82ND St
Ste F
Indianapolis, IN 46250-4698
Phone (317) 842-1903

National Provider Directory

National Provider Directory

Locations

5511 E 82nd St
Ste F
Indianapolis, IN 46250
Phone (317) 842-1903

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428278400000",
    "number": "1689067928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5511 E 82ND ST",
            "address_2": "STE 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": "STE F",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462504698",
            "telephone_number": "317-842-1903",
            "fax_number": "317-849-8054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK E NICEWANDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-11",
        "last_updated": "2015-04-06",
        "status": "A",
        "authorized_official_last_name": "NICEWANDER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-842-1903",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IN",
            "license": "12007501A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; 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.