MEDICARE: DR. DANIELLE ANN NICI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	25503	OK
2	1223P0300X	Periodontics	DDS-09961	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DDS-09961	OTHER	IA	IOWA DENTAL BOARD

General Provider Information

NPI Number	:	1083368229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE ANN NICI DDS

Provider Business Mailing Address
First Line	:	1325 N WALKER AVE APT 338
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-6402
Country	:	US
Telephone Number	:	516-333-5935
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 MALL DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3111
Country	:	US
Telephone Number	:	319-337-3588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	05/05/2026

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