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NPI Code Detail

MEDICARE: ELIZABETH NICOLAS DDS

MEDICARE: ELIZABETH NICOLAS DDS
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
1122300000XDentist109263CA

General Provider Information

NPI Number : 1982482089
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH NICOLAS DDS
Provider Business Mailing Address
First Line : 1328 S MISSION RD
Second Line :
City : FALLBROOK
State : CA
Zip : 92028-4006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1328 S MISSION RD
Second Line :
City : FALLBROOK
State : CA
Zip : 92028-4006
Country : US
Telephone Number : 760-451-4720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2023
Last Update Date : 03/12/2026

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Directions to “ ELIZABETH NICOLAS DDS” Practice Location

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