Active NPI
Nicole Makhoul, DDS
- General Practice Dentistry
- Cambridge, MA
National Provider Identifier
1720316227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN1855300
- Practice address
- 1 Porter SQ
Suite 11
Cambridge, MA 02140-1431 - Phone
- (678) 904-5665
- NPI assigned
- Nov 23, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN1855300 | MA | Primary |
Addresses
Primary practice location
1 Porter SQ
Suite 11
Cambridge, MA 02140-1431
Mailing address
400 Galleria Pkwy SE
Suite 800
Atlanta, GA 30339-5980
Phone (679) 904-5665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160816002314 | MA | Order and Referring Only - Oral Surgery | 4880989771 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1855300 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258934400000",
"number": "1720316227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 GALLERIA PKWY SE",
"address_2": "SUITE 800",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303395980",
"telephone_number": "679-904-5665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 PORTER SQ",
"address_2": "SUITE 11",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021401431",
"telephone_number": "678-904-5665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAKHOUL",
"first_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-11-23",
"last_updated": "2009-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN1855300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.