Individual
FAUSTO NICIEZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1491 E 4TH AVE, HIALEAH, FL 33010-3527
(305) 888-8260
(305) 888-5563
Mailing address
1491 E 4TH AVE, HIALEAH, FL 33010-3527
(305) 888-8260
(305) 888-5563
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN15528
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016821300
—
FL
01
—
651053975
TAX ID #
FL
Enumeration date
08/23/2006
Last updated
04/01/2016
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