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NPI Code Detail

MEDICARE: PATRICK V. NICOSIA DDS, MS

MEDICARE:   PATRICK V. NICOSIA  DDS, MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodontics8564TX

General Provider Information

NPI Number : 1689610404
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK V. NICOSIA DDS, MS
Provider Business Mailing Address
First Line : 7700 SAN FELIPE ST STE 340
Second Line :
City : HOUSTON
State : TX
Zip : 77063-1613
Country : US
Telephone Number : 713-781-4072
Fax Number :
Provider Business Practice Location Address
First Line : 7700 SAN FELIPE ST STE 340
Second Line :
City : HOUSTON
State : TX
Zip : 77063-1613
Country : US
Telephone Number : 713-781-4072
Fax Number : 713-952-4801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 07/08/2007

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Directions to “ PATRICK V. NICOSIA DDS, MS” Practice Location

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