Provider Demographics
NPI:1063564995
Name:JESSICA DE LEON NICHOLAS DDS INC
Entity type:Organization
Organization Name:JESSICA DE LEON NICHOLAS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-486-0214
Mailing Address - Street 1:3725 SAVIERS ROAD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-6432
Mailing Address - Country:US
Mailing Address - Phone:805-486-0214
Mailing Address - Fax:805-240-3470
Practice Address - Street 1:3725 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6432
Practice Address - Country:US
Practice Address - Phone:805-486-0214
Practice Address - Fax:805-240-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty