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General NPI Number Information
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NPI Number | 1205211398
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Entity Type | Organization
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Legal Business Name | EPIFANIA V NICOLAS DDS INC
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 301 E HOBSONWAY
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City | BLYTHE
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State | CA
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Zip | 92225-1732
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Country | US
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Telephone | 760-922-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 301 E HOBSONWAY
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City | BLYTHE
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State | CA
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Zip | 92225-1732
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Country | US
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Telephone | 760-922-2300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EPIFANIA NICOLAS
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Credential | DDS
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Telephone | 760-922-2300
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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 | 40290
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License Number State | CA
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