Organization
NICOLAS S. VEACO, M.D., D.D.S., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLAS S VEACO M.D., D.D.S. (SOLE OWNER/PRESIDENT)
(209) 951-9045
Entity
Organization
Contact information
Practice address
3427 DEER PARK DR, STE B, STOCKTON, CA 95219-2355
(209) 951-9045
(209) 951-9047
Mailing address
3427 DEER PARK DR, STE B, STOCKTON, CA 95219-2355
(209) 951-9045
(209) 951-9047
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
00G678190
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ26433Z
MEDICARE PTAN
CA
Enumeration date
02/12/2009
Last updated
06/21/2018
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