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General NPI Number Information
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NPI Number | 1063564995
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Entity Type | Organization
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Legal Business Name | JESSICA DE LEON NICHOLAS DDS INC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 3725 SAVIERS RD
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City | OXNARD
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State | CA
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Zip | 93033-6432
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Country | US
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Telephone | 805-486-0214
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Fax | 805-240-3470
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Provider Business Mailing Address
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Address Line | 3725 SAVIERS ROAD
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City | OXNARD
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State | CA
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Zip | 93033-6432
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Country | US
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Telephone | 805-486-0214
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Fax | 805-240-3470
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | JESSICA L NICHOLAS
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Credential | DDS
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Telephone | 805-486-0214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36590
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License Number State | CA
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