| Nieto Dental Corp | |
|
78995 Highway 111 Ste 3 La Quinta CA 92253-2397 | |
| (760) 771-8887 | |
| Not Available |
| Full Name | Nieto Dental Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 78995 Highway 111 Ste 3, La Quinta, California |
| Authorized Official Name and Position | Angelica M Nieto (OWNER) |
| Authorized Official Contact | 7607718887 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nieto Dental Corp 78995 Highway 111 Ste 3 La Quinta CA 92253-2397 Ph: (760) 771-8887 | Nieto Dental Corp 78995 Highway 111 Ste 3 La Quinta CA 92253-2397 Ph: (760) 771-8887 |
| NPI Number | 1265087985 |
|---|---|
| Provider Enumeration Date | 08/08/2019 |
| Last Update Date | 02/15/2021 |
| Medicare PECOS PAC ID | 6507272051 |
|---|---|
| Medicare Enrollment ID | O20210308000949 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265087985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Angelica Nieto |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1891084836 PECOS PAC ID: 9133535685 Enrollment ID: I20210308001052 |
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