Healthcare Provider Details

I. General information

NPI: 1225228083
Provider Name (Legal Business Name): NICHOLAS N.GADLER, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 S PIERCE ST
EL CAJON CA
92020-4124
US

IV. Provider business mailing address

366 S PIERCE ST
EL CAJON CA
92020-4124
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-8880
  • Fax: 619-334-8885
Mailing address:
  • Phone: 619-334-8880
  • Fax: 619-334-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD40239
License Number StateCA

VIII. Authorized Official

Name: NICHOLAS NOEL GADLER
Title or Position: OWNER
Credential: DDS
Phone: 619-334-8880