MEDICARE: NICK I DEVANI D.D.S.

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
1	122300000X	Dentist	41397	CA

General Provider Information

NPI Number	:	1811049638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK I DEVANI D.D.S.

Provider Business Mailing Address
First Line	:	10601 WALKER ST
Second Line	:	SUITE 210
City	:	CYPRESS
State	:	CA
Zip	:	90630-4733
Country	:	US
Telephone Number	:	714-828-6331
Fax Number	:	714-828-2966

Provider Business Practice Location Address
First Line	:	10601 WALKER ST
Second Line	:	SUITE 210
City	:	CYPRESS
State	:	CA
Zip	:	90630-4733
Country	:	US
Telephone Number	:	714-828-6331
Fax Number	:	714-828-2966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	12/12/2014

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