Active NPI
Jonathan Robert Nichols, D.M.D.
- Pediatric Dentistry
- Hattiesburg, MS
National Provider Identifier
1689085474
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 3761-14
- Practice address
- 6643 U S Highway 98
Hattiesburg, MS 39402-8442 - Phone
- (601) 450-6060
- Fax
- (601) 450-6062
- NPI assigned
- May 14, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 3761-14 | MS | Primary |
Addresses
Primary practice location
6643 U S Highway 98
Hattiesburg, MS 39402-8442
Mailing address
6643 Highway 98
Hattiesburg, MS 39402
Phone (601) 450-6060
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 |
|---|---|---|---|
| 3761-14 | MS | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472688000000",
"number": "1689085474",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6643 HIGHWAY 98",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "39402",
"telephone_number": "601-450-6060",
"fax_number": "601-450-6062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6643 U S HIGHWAY 98",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394028442",
"telephone_number": "601-450-6060",
"fax_number": "601-450-6062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "JONATHAN",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-14",
"last_updated": "2016-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MS",
"license": "3761-14",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.