Provider Demographics
NPI:1740388834
Name:NICACIO, PABLO ESTEBAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:ESTEBAN
Last Name:NICACIO
Suffix:
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 1:540 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2108
Mailing Address - Country:US
Mailing Address - Phone:541-567-4143
Mailing Address - Fax:541-567-0264
Practice Address - Street 1:540 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2108
Practice Address - Country:US
Practice Address - Phone:541-567-4143
Practice Address - Fax:541-567-0264
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist