Provider Demographics
NPI:1669717849
Name:CORONEL, NICHOLAS ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:CORONEL
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 BANDERA RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4265
Mailing Address - Country:US
Mailing Address - Phone:210-318-4119
Mailing Address - Fax:210-372-9795
Practice Address - Street 1:12415 BANDERA RD STE 110
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4265
Practice Address - Country:US
Practice Address - Phone:210-318-4119
Practice Address - Fax:210-372-9795
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0573561223G0001X
VA04014131401223G0001X
TX31266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice