Nicole Jean Reardon, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13043 Issued in MN

Practice address

520 Main Street
Hawley, MN 56549-0849

Phone

(218) 483-1038

NPI assigned

May 15, 2012

Last updated

May 15, 2012By the provider in NPPES

Sex

Female

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 MN

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

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.

• Apple Tree Dental

  • General Practice Dentistry
  • Hawley, MN
  • NPI 1346301454
  NPD (past)

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337040000000",
    "number": "1831458504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849",
            "city": "HAWLEY",
            "state": "MN",
            "postal_code": "565490849",
            "telephone_number": "218-483-1038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MAIN STREET",
            "city": "HAWLEY",
            "state": "MN",
            "postal_code": "565490849",
            "telephone_number": "218-483-1038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REARDON",
        "first_name": "NICOLE",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-15",
        "last_updated": "2012-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nudak Ventures LLC (NuCara Pharmacy #38)
• Katlyn Olson, PT, DPT
• Neha Patel, DDS
• Devon Pekas, MD, MS
• Nicole M. Perman, CCC-SLP
• Sanford Clinic North (Sanford Hawley Clinic)
• Sanford Medical Center Fargo (Sanford Hawley Clinic)
• Kaitlin Siewert
• Garrett Allen Skonseng, DDS
• Krista Southwick, PHARMD

• General Practice Dentistry in Hawley, MN
• Providers in Hawley, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; 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.