NPIMap

Organization Active NPI

Scott Nigl Dental PC

  • General Practice Dentistry
  • Fort Gratiot, MI
National Provider Identifier
1952791949
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
18564 Issued in MI
Legal business name
SCOTT NIGL DENTAL PC
Practice address
4216 24TH Ave
Ste 100
Fort Gratiot, MI 48059-3880
Phone
(810) 984-8669
Fax
(810) 385-6157
NPI assigned
Jan 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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

Authorized official

Name
Jason Bertollini
Title
PRM
Phone
(866) 273-8204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 18564 MI Primary

Addresses

Primary practice location

4216 24TH Ave
Ste 100
Fort Gratiot, MI 48059-3880

Mailing address

PO Box 3189
Syracuse, NY 13220-3189
Phone (866) 273-8204

National Provider Directory

National Provider Directory

Locations

4216 24th Ave
Ste 100
Fort Gratiot, MI 48059
Phone (810) 984-8669

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1952791949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "866-273-8204",
            "fax_number": "866-803-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4216 24TH AVE",
            "address_2": "STE 100",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593880",
            "telephone_number": "810-984-8669",
            "fax_number": "810-385-6157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT NIGL DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-28",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "BERTOLLINI",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRM",
        "authorized_official_telephone_number": "866-273-8204"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "18564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gratiot, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; 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.