Provider Demographics
NPI:1336404995
Name:DAVID NIEMIEC D.D.S. ,INC.
Entity Type:Organization
Organization Name:DAVID NIEMIEC D.D.S. ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMIEC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-265-7664
Mailing Address - Street 1:601 DOVER DR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-5735
Mailing Address - Country:US
Mailing Address - Phone:765-265-7664
Mailing Address - Fax:
Practice Address - Street 1:601 DOVER DR
Practice Address - Street 2:SUITE 12
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5735
Practice Address - Country:US
Practice Address - Phone:765-265-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA603581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty