Provider Demographics
NPI:1184819864
Name:NICOSIA, GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:NICOSIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 38TH ST STE G5
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1134
Mailing Address - Country:US
Mailing Address - Phone:512-453-1600
Mailing Address - Fax:512-453-1503
Practice Address - Street 1:711 W 38TH ST STE G5
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1134
Practice Address - Country:US
Practice Address - Phone:512-453-1600
Practice Address - Fax:512-453-1503
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics