MEDICARE: DR. NATHAN COOPER NILES D.D.S.

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	1223G0001X	General Practice Dentistry	60023	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	116545	OTHER	KS	BLUE CROSS BLUE SHIELD
3	60023	OTHER	KS	DELTA DENTAL PROVIDER #
4	1004953	OTHER	KS	DORAL PROVIDER #

General Provider Information

NPI Number	:	1851381594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN COOPER NILES D.D.S.

Provider Business Mailing Address
First Line	:	112 E CENTRAL AVE
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-2602
Country	:	US
Telephone Number	:	620-442-2575
Fax Number	:	620-442-2570

Provider Business Practice Location Address
First Line	:	112 E CENTRAL AVE
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-2602
Country	:	US
Telephone Number	:	620-442-2575
Fax Number	:	620-442-2570

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	06/20/2012

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