Provider Demographics
NPI:1063740991
Name:NICOLAS, MANOLO PASCUAL (DMD)
Entity type:Individual
Prefix:
First Name:MANOLO
Middle Name:PASCUAL
Last Name:NICOLAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-665-1261
Mailing Address - Fax:323-667-0850
Practice Address - Street 1:5126 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-665-1261
Practice Address - Fax:323-667-0850
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice