Robert Nidea

Primary specialty

DentistTaxonomy code 122300000X

License

019-022446 Issued in IL

Practice address

16280 Prince Dr
South Holland, IL 60473-3233

Phone

(708) 225-1866

NPI assigned

Dec 11, 2006

Last updated

Aug 16, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Infinity Smile LTD

  • Dental Clinic/Center
  • South Holland, IL
  • NPI 1144247230
  NPD (past)

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1790845725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "733 S HILLSIDE AVE",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601264719",
            "telephone_number": "210-845-5879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16280 PRINCE DR",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604733233",
            "telephone_number": "708-225-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIDEA",
        "first_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-022446",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22529",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chuka Joseph Obanyego Nchekwube, MD
• Senora Nelson, MD
• New Hope Center/ Phoenix Court
• Charles Elbert Newman, L.M.T.
• Heidi Azmy Nicola, M.D.
• Natasha N Noorian
• Jennifer Norris Rosas, A.P.N.
• NP PRN LLP (NP PRN Services)
• Nse Ekpenyong, DDS, PC
• Alphecca May T. Octava, DC, MSAC

• Dentist in South Holland, IL
• Providers in South Holland, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; 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.