Provider Demographics
NPI:1851598718
Name:SAMPIETRO, NICHOLAS JON (DDS)
Entity Type:Individual
Prefix:MISS
First Name:NICHOLAS
Middle Name:JON
Last Name:SAMPIETRO
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 1:1910 N MAE CARDEN
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-625-0265
Mailing Address - Fax:559-625-6083
Practice Address - Street 1:1140 N CHINOWTH
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4113
Practice Address - Country:US
Practice Address - Phone:559-625-0265
Practice Address - Fax:559-625-6083
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist