Provider Demographics
NPI:1225228083
Name:NICHOLAS N.GADLER, DDS, INC
Entity Type:Organization
Organization Name:NICHOLAS N.GADLER, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:GADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-334-8880
Mailing Address - Street 1:366 S PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4124
Mailing Address - Country:US
Mailing Address - Phone:619-334-8880
Mailing Address - Fax:619-334-8885
Practice Address - Street 1:366 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4124
Practice Address - Country:US
Practice Address - Phone:619-334-8880
Practice Address - Fax:619-334-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD402391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91608-01Medicaid
CAG91608-01Medicaid