NPIMap

Individual provider Active NPI

Bruce R Nicol, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Lexington, KY
National Provider Identifier
1740237064
Registry record updated Feb 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
4461 Issued in KY
Practice address
2533 Larkin Rd
Suite 204
Lexington, KY 40503-3278
Phone
(859) 278-9376
Fax
(859) 276-0260
NPI assigned
May 30, 2006
Last updated
Feb 10, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2016

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 4461 KY
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 4461 KY
Pediatric Dentistry 1223P0221X 4461 KY
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 4461 KY Primary

Addresses

Primary practice location

2533 Larkin Rd
Suite 204
Lexington, KY 40503-3278

Mailing address

2533 Larkin Rd
Suite 204
Lexington, KY 40503-3278
Phone (859) 278-9376

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Previously, effective Oct 4, 2016 through Oct 4, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4461KYMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Center for Oral & Maxillofacial Surgery Oral & Maxillofacial Surgery Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery PSC Oral and Maxillofacial Surgery Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery PSC Dentist Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery PSC Oral and Maxillofacial Surgery Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery Oral & Maxillofacial Surgery Past Accepting new patients
Kentucky Center for Oral & Maxillofacial Surgery Oral & Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455062400000",
    "number": "1740237064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2533 LARKIN RD",
            "address_2": "SUITE 204",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033278",
            "telephone_number": "859-278-9376",
            "fax_number": "859-276-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2533 LARKIN RD",
            "address_2": "SUITE 204",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033278",
            "telephone_number": "859-278-9376",
            "fax_number": "859-276-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOL",
        "first_name": "BRUCE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2016-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "4461",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "4461",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "4461",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "4461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.