Physician Compare National (NPI:1215940952)

HEALTHCARE PROVIDER: DAVID WILLIAM NICHOLLS D.D.S.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1215940952
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4385821537
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161111001678
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NICHOLLS
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIV OF CALIF, SAN FRANCISCO SCHOOL OF DENTISTRY
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CUMMINGS BALASANIAN CAPUTO AND NICHOLLS DENTAL GROUP INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	5395639066
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	26302 LA PAZ RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	MISSION VIEJO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	926915327
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9495867000
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y