| Philip M. Nisco, D.d.s., Inc | |
|
17720 Newhope St Suite #227 Fountain Valley CA 92708 | |
| (714) 979-1400 | |
| (714) 979-1403 |
| Full Name | Philip M. Nisco, D.d.s., Inc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 17720 Newhope St, Fountain Valley, California |
| Authorized Official Name and Position | Philip Matthew Nisco (ORTHODONTIST/OWNER) |
| Authorized Official Contact | 7149791400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Philip M. Nisco, D.d.s., Inc 17720 Newhope St Suite #227 Fountain Valley CA 92708 Ph: (714) 979-1400 | Philip M. Nisco, D.d.s., Inc 17720 Newhope St Suite #227 Fountain Valley CA 92708 Ph: (714) 979-1400 |
| NPI Number | 1194913673 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 10/07/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194913673 | NPI | - | NPPES |
| G92261-01 | Other | CA | DENTI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 032598 (California) | Primary |
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