Kent N Nicklas, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30.018994 Issued in OH

Practice address

633 W Bagley Rd
Berea, OH 44017-1356

Phone

(440) 234-4646

Fax

(440) 234-1868

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1750395638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 W BAGLEY RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171356",
            "telephone_number": "440-234-4646",
            "fax_number": "440-234-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 W BAGLEY RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171356",
            "telephone_number": "440-234-4646",
            "fax_number": "440-234-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKLAS",
        "first_name": "KENT",
        "middle_name": "N",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.018994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Murdock
• Miranda Lynn Myers
• Nathaniel Hamm DPM, LLC
• Teeana Newell
• Barbara Anne Nicely, PH.D.
• Kathryn Niemczura
• Tiffany Marie Noble
• Rosalina Sambre Noga
• Angie Nolan
• Kevin Norris

• General Practice Dentistry in Berea, OH
• Providers in Berea, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.

Verify at the official NPI Registry.