Nicole Suberville Wascom, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

5288 Issued in LA

Practice address

22464 Highway 435
Abita Springs, LA 70420-2206

Phone

(985) 893-7835

Fax

(985) 893-3867

NPI assigned

Jun 8, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Grand Family Dentistry Abita Springs LLC

  • General Practice Dentistry
  • Abita Springs, LA
  • NPI 1114736774
  NPD (past)
• Louis P. Nogues, III, DDS, a Professional Corp.

  • General Practice Dentistry
  • Abita Springs, LA
  • NPI 1588721179
  NPD (past)

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982807632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22464 HIGHWAY 435",
            "city": "ABITA SPRINGS",
            "state": "LA",
            "postal_code": "704202206",
            "telephone_number": "985-893-7835",
            "fax_number": "985-893-3867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22464 HIGHWAY 435",
            "city": "ABITA SPRINGS",
            "state": "LA",
            "postal_code": "704202206",
            "telephone_number": "985-893-7835",
            "fax_number": "985-893-3867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASCOM",
        "first_name": "NICOLE",
        "middle_name": "SUBERVILLE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "5288",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1852881",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Stout, LCSW
• Telerad of la Account Management, LLC
• The Well Life Integrative Health Inc
• Eric Valverde, PLPC
• Walgreen Co
• Angela Wilkie, PT

• Dentist in Abita Springs, LA
• Providers in Abita Springs, LA by specialty
• Dentist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.