Provider Demographics
NPI:1164501409
Name:NICCOLI, DOMINIC JOSEPH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:JOSEPH
Last Name:NICCOLI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16336 WHITTIER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2900
Mailing Address - Country:US
Mailing Address - Phone:562-693-8895
Mailing Address - Fax:562-943-0299
Practice Address - Street 1:16336 WHITTIER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2900
Practice Address - Country:US
Practice Address - Phone:562-693-8895
Practice Address - Fax:562-943-0299
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics