Russell Dewitt Nichols, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4810A1 Issued in AL

Practice address

812 Boll Weevil Cir
Enterprise, AL 36330-2079

Phone

(334) 347-9283

Fax

(334) 347-7664

NPI assigned

Jun 5, 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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Fresh Wave Dental Care

  • Dentist
  • Enterprise, AL
  • NPI 1134392517
  NPD (past)

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207612800000",
    "number": "1780623843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 E KINGSWOOD DR",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363304119",
            "telephone_number": "334-347-9283",
            "fax_number": "334-347-7664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 BOLL WEEVIL CIR",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302079",
            "telephone_number": "334-347-9283",
            "fax_number": "334-347-7664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "RUSSELL",
        "middle_name": "DEWITT",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2008-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "4810A1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51027316",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "487225",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA",
            "identifier": "4810",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa R Neal, LMSW
• Benjamin James Nelson, MD
• Hailie Nelson
• New Horizons Wellness Center
• New Perspective Counseling Services, LLC
• Jarret Travis Nielson
• Northern Alabama Physicians, LLP
• Nourished Mind Counseling Services, LLV
• Oak Park Dental LLC
• Abby Spitler Olive, FNP-BC

• General Practice Dentistry in Enterprise, AL
• Providers in Enterprise, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.