Kent N Nicklas DDS Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18994 Issued in OH

Legal business name

KENT N NICKLAS DDS INC.

Practice address

633 W Bagley Rd
Berea, OH 44017-1356

Phone

(440) 234-4646

Fax

(440) 234-1868

NPI assigned

Apr 24, 2008

Organization subpart

No

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

Authorized official

Name

Kent N Nicklas, DDS

Title

Owner/Dentist

Phone

(440) 234-4646

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1982879649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 W BAGLEY RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171356",
            "telephone_number": "440-234-4646",
            "fax_number": "440-234-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 W BAGLEY RD",
            "city": "BEREA",
            "state": "OH",
            "postal_code": "440171356",
            "telephone_number": "440-234-4646",
            "fax_number": "440-234-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT N NICKLAS DDS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "NICKLAS",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "440-234-4646",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "18994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John James Kavlich III, MD
• Carol Amelia Kavulic, PC
• Lalene Dyshere Kay, MT-BC, ACC
• Cheryl Lynn Kelley
• Sharon Kennedy
• Carollee Kepler, QMHS 3YRS
• Kenneth James Kerns III, PRS
• Carol Lynn Kessel, LPN
• Shaden Khayat
• Elizabeth Kiefer

• General Practice Dentistry in Berea, OH
• Providers in Berea, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.