Active NPI
Nichole McKenna, DDS
- Public Health Dentistry
- Oakland, CA
National Provider Identifier
1740629864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 63781
- Practice address
- 2950 International Blvd
Oakland, CA 94601-2228 - Phone
- (415) 621-8056
- NPI assigned
- Jun 21, 2013
- 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 |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 63781 | CA | Primary |
Addresses
Primary practice location
2950 International Blvd
Oakland, CA 94601-2228
Mailing address
11670 Atwood Rd
Auburn, CA 95603-9522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151005003136 | CA | Order and Referring Only - Other (Non-Physician) | 6204144611 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63781 | CA | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416355200000",
"number": "1740629864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11670 ATWOOD RD",
"city": "AUBURN",
"state": "CA",
"postal_code": "956039522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2950 INTERNATIONAL BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012228",
"telephone_number": "415-621-8056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENNA",
"first_name": "NICHOLE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-21",
"last_updated": "2014-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "CA",
"license": "63781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; 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.