Organization
NIETO DENTAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELICA M NIETO (OWNER)
(760) 771-8887
Entity
Organization
Contact information
Practice address
78995 HIGHWAY 111 STE 3, LA QUINTA, CA 92253-2397
(760) 771-8887
Mailing address
78995 HIGHWAY 111 STE 3, LA QUINTA, CA 92253-2397
(760) 771-8887
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
08/08/2019
Last updated
02/15/2021
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