Provider Demographics
NPI:1578774550
Name:RALPH A. NICASSIO D.D.S.
Entity Type:Organization
Organization Name:RALPH A. NICASSIO D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICASSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-868-7768
Mailing Address - Street 1:11936 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3000
Mailing Address - Country:US
Mailing Address - Phone:562-868-7768
Mailing Address - Fax:562-863-2369
Practice Address - Street 1:11936 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3000
Practice Address - Country:US
Practice Address - Phone:562-868-7768
Practice Address - Fax:562-863-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB336421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty