Provider Demographics
NPI:1962661611
Name:NICOLAS, EPIFANIA VIOLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EPIFANIA
Middle Name:VIOLA
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 DIAMOND VIEW ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7962
Mailing Address - Country:US
Mailing Address - Phone:714-906-9116
Mailing Address - Fax:
Practice Address - Street 1:1637 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2406
Practice Address - Country:US
Practice Address - Phone:714-906-9116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4029004Medicaid