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General NPI Number Information
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NPI Number | 1700071065
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Entity Type | Organization
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Legal Business Name | NICASIO ABRIOL DMD INC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1512 S EL DORADO ST
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City | STOCKTON
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State | CA
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Zip | 95206-2020
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Country | US
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Telephone | 209-465-1254
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Fax | 209-465-0854
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Provider Business Mailing Address
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Address Line | 1512 S EL DORADO ST
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City | STOCKTON
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State | CA
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Zip | 95206-2020
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Country | US
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Telephone | 209-465-1254
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Fax | 209-465-0854
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Authorized Official
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Title or Position | MANAGER
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Name | DEBBIE HENRY
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Credential |
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Telephone | 209-465-1254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 43301
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License Number State | CA
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