Provider Demographics
NPI:1275604696
Name:NICKEL, ALFRED A JR (DDS)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:A
Last Name:NICKEL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 EMBARCADERO DR
Mailing Address - Street 2:#102
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4097
Mailing Address - Country:US
Mailing Address - Phone:916-934-3403
Mailing Address - Fax:
Practice Address - Street 1:897 EMBARCADERO DR
Practice Address - Street 2:#102
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4097
Practice Address - Country:US
Practice Address - Phone:916-934-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237421223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology