Provider Demographics
NPI:1467642470
Name:FAUSTO NICIEZA D.M.D.,P.A.
Entity Type:Organization
Organization Name:FAUSTO NICIEZA D.M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAUSTO
Authorized Official - Middle Name:
Authorized Official - Last Name:NICIEZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-888-8260
Mailing Address - Street 1:1491 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3527
Mailing Address - Country:US
Mailing Address - Phone:305-888-8260
Mailing Address - Fax:305-888-5531
Practice Address - Street 1:1491 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3527
Practice Address - Country:US
Practice Address - Phone:305-888-8260
Practice Address - Fax:305-888-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty