Healthcare Provider Details

I. General information

NPI: 1780745802
Provider Name (Legal Business Name): NICHOLAS NOEL GADLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/05/2013
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:
Title or Position:
Credential:
Phone: