Nikolina Petrasevic Nielsen, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60146593 Issued in WA

Practice address

1211 Main St
Sumner, WA 98390-1416

Phone

(253) 863-4400

Fax

(206) 768-5382

NPI assigned

Nov 2, 2009

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 2, 2021 through Feb 2, 2027

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.

• Sumner Smiles Dentistry

  • Dentist
  • Sumner, WA
  • NPI 1861948713
  NPD (past) Authorized official

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1992031512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 S COLUMBIAN WAY",
            "address_2": "DENTAL CLINIC",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981081532",
            "telephone_number": "206-764-2334",
            "fax_number": "206-768-5382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 MAIN ST",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983901416",
            "telephone_number": "253-863-4400",
            "fax_number": "206-768-5382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "NIKOLINA",
        "middle_name": "PETRASEVIC",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-02",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60146593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Navdeep Dhaliwal and Manpreet Dhaliwal DDS PLLC (Complete Dental Care of Sumner)
• Nghi Que Ngo, FNP-C
• Mindy Nichols, R.D., C.D.E.
• Nicholsons Sumner Pharmacy Inc
• Christopher John Nielsen, D.M.D
• Melissa Marie Noren, LMT
• Kelsey Marie O'Brien, PT, DPT
• Old Cannery Furniture Warehouse LLC (The Old Cannery)
• Brandi M Olsen, LMP
• Nolan Shawn Omalley, DPT

• General Practice Dentistry in Sumner, WA
• Providers in Sumner, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.