Organization
PHILIP M. NISCO, D.D.S., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP MATTHEW NISCO DDS (ORTHODONTIST/OWNER)
(714) 979-1400
Entity
Organization
Contact information
Practice address
17720 NEWHOPE ST, SUITE #227, FOUNTAIN VALLEY, CA 92708
(714) 979-1400
(714) 979-1403
Mailing address
17720 NEWHOPE ST, SUITE #227, FOUNTAIN VALLEY, CA 92708
(714) 979-1400
(714) 979-1403
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
032598
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G92261-01
DENTI-CAL
CA
Enumeration date
10/09/2007
Last updated
10/07/2015
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