Philip M. Nisco, D.D.S., Inc

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

032598 Issued in CA

Legal business name

PHILIP M. NISCO, D.D.S., INC

Practice address

17720 Newhope St
Suite #227
Fountain Valley, CA 92708

Phone

(714) 979-1400

Fax

(714) 979-1403

NPI assigned

Oct 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Philip Matthew Nisco, DDSNPI 1801019443

Title

Orthodontist/Owner

Phone

(714) 979-1400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Matthew Nisco, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fountain Valley, CA
  • NPI 1801019443
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1194913673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17720 NEWHOPE ST",
            "address_2": "SUITE #227",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "92708",
            "telephone_number": "714-979-1400",
            "fax_number": "714-979-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17720 NEWHOPE ST",
            "address_2": "SUITE #227",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "92708",
            "telephone_number": "714-979-1400",
            "fax_number": "714-979-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILIP M. NISCO, D.D.S., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "NISCO",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "ORTHODONTIST/OWNER",
        "authorized_official_telephone_number": "714-979-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "032598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI-CAL",
            "identifier": "G92261-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.