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Individual

DR. NATHAN COOPER NILES

Active
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Individual

DR. NATHAN COOPER NILES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60023
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100365030A
—
KS
01
—
1004953
DORAL PROVIDER #
KS
01
—
116545
BLUE CROSS BLUE SHIELD
KS
01
—
60023
DELTA DENTAL PROVIDER #
KS
Enumeration date
10/25/2005
Last updated
06/20/2012
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