Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 23742 | CA |
NPI | 1275604696 |
---|---|
Provider Name | Alfred A Nickel JR. |
First Address | El Dorado Hills, CA 95762-4097 |
Second Address | El Dorado Hills, CA 95762-4097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |