Active NPI
William R Nichols, DDS
- Dentist
- Los Alamos, NM
National Provider Identifier
1760757264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD3624
- Practice address
- 751 Trinity Dr Ste 305
Los Alamos, NM 87544-3357 - Phone
- (505) 661-9060
- Fax
- (505) 738-0338
- NPI assigned
- Mar 15, 2012
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DD3624 | NM | Primary |
Addresses
Primary practice location
751 Trinity Dr Ste 305
Los Alamos, NM 87544-3357
Mailing address
4701 Lomas Blvd NE
Albuquerque, NM 87110
Phone (505) 433-5204
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568883338 | Medicaid | NM |
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 |
|---|---|---|---|
| DD3624 | NM | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kids Dental Partners, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Los Alamos, NM
- NPI 1568883338
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651622400000",
"number": "1760757264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4701 LOMAS BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87110",
"telephone_number": "505-433-5204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 TRINITY DR STE 305",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875443357",
"telephone_number": "505-661-9060",
"fax_number": "505-738-0338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "WILLIAM",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-15",
"last_updated": "2022-05-04",
"certification_date": "2022-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD3624",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1568883338",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Alamos, NM
- National Sinus Institute PLLC
- John Bennett Neal, MD
- Jennifer B Neil, LISW
- New Mexico Em-I Medical Services
- Michael W Nichols, MD
- North Star Psychiatric Services LLC
- North Star Psychiatric Services, LLC
- Northern New Mexico Counseling Services, L.L.C.
- Northern New Mexico Surgery
- Northern New Mexico Urology LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.