Active NPI
Nigist Tadesse, DDS
- Dentist
- Niceville, FL
National Provider Identifier
1982384228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 28438
- Practice address
- 1156 John Sims Pkwy E
Niceville, FL 32578-2204 - Phone
- (407) 923-7155
- NPI assigned
- Jul 21, 2023
- Last updated
- Jul 24, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 28438 | FL | Primary |
Addresses
Primary practice location
1156 John Sims Pkwy E
Niceville, FL 32578-2204
Mailing address
18 West Sky Way
Freeport, FL 32439-2204
Phone (407) 923-7155
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 |
|---|---|---|---|
| 28438 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690156800000",
"number": "1982384228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 WEST SKY WAY",
"city": "FREEPORT",
"state": "FL",
"postal_code": "324392204",
"telephone_number": "407-923-7155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1156 JOHN SIMS PKWY E",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325782204",
"telephone_number": "407-923-7155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TADESSE",
"first_name": "NIGIST",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-21",
"last_updated": "2023-07-24",
"certification_date": "2023-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "28438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.