Provider Demographics
NPI:1700071065
Name:NICASIO ABRIOL DMD INC
Entity Type:Organization
Organization Name:NICASIO ABRIOL DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-465-1254
Mailing Address - Street 1:1512 S EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-2020
Mailing Address - Country:US
Mailing Address - Phone:209-465-1254
Mailing Address - Fax:209-465-0854
Practice Address - Street 1:1512 S EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2020
Practice Address - Country:US
Practice Address - Phone:209-465-1254
Practice Address - Fax:209-465-0854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MT.PLEASANT DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43301261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental