Provider Demographics
NPI:1851381594
Name:NILES, NATHAN COOPER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:COOPER
Last Name:NILES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-2602
Mailing Address - Country:US
Mailing Address - Phone:620-442-2575
Mailing Address - Fax:620-442-2570
Practice Address - Street 1:112 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-2602
Practice Address - Country:US
Practice Address - Phone:620-442-2575
Practice Address - Fax:620-442-2570
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS600231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100365030AMedicaid
KS116545OtherBLUE CROSS BLUE SHIELD
KS60023OtherDELTA DENTAL PROVIDER #
KS1004953OtherDORAL PROVIDER #