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NPI Code Detail

MEDICARE: DR. NICOLE O'PALLICK DDS

MEDICARE: DR. NICOLE O'PALLICK 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
11223G0001XGeneral Practice Dentistry64823CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356727184
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLE O'PALLICK DDS
Provider Business Mailing Address
First Line : 27140 MANOR CIR
Second Line :
City : VALENCIA
State : CA
Zip : 91354-2691
Country : US
Telephone Number : 541-971-3183
Fax Number :
Provider Business Practice Location Address
First Line : 755 W RANCHO VISTA BLVD
Second Line :
City : PALMDALE
State : CA
Zip : 93551-3735
Country : US
Telephone Number : 661-265-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2015
Last Update Date : 03/05/2019

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