NPIMap

Organization Active NPI

Nicolas S. Veaco, M.D., D.D.S., a Professional Corporation

  • Oral and Maxillofacial Surgery (Dentist)
  • Stockton, CA
National Provider Identifier
1982843033
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
00G678190 Issued in CA
Legal business name
NICOLAS S. VEACO, M.D., D.D.S., A PROFESSIONAL CORPORATION
Practice address
3427 Deer Park Dr
Ste B
Stockton, CA 95219-2355
Phone
(209) 951-9045
Fax
(209) 951-9047
NPI assigned
Feb 12, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Authorized official

Name
Dr. Nicolas S Veaco, M.D., D.D.S.NPI 1992810337
Title
Sole Owner/President
Phone
(209) 951-9045

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 00G678190 CA Primary

Addresses

Primary practice location

3427 Deer Park Dr
Ste B
Stockton, CA 95219-2355

Mailing address

3427 Deer Park Dr
Ste B
Stockton, CA 95219-2355
Phone (209) 951-9045

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ26433ZOtherCAMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

3427 Deer Park Dr
Ste B
Stockton, CA 95219
Phone (209) 951-9045

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1982843033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3427 DEER PARK DR",
            "address_2": "STE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192355",
            "telephone_number": "209-951-9045",
            "fax_number": "209-951-9047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3427 DEER PARK DR",
            "address_2": "STE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952192355",
            "telephone_number": "209-951-9045",
            "fax_number": "209-951-9047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLAS S. VEACO, M.D., D.D.S., A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-12",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "VEACO",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SOLE OWNER/PRESIDENT",
        "authorized_official_telephone_number": "209-951-9045",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "00G678190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE  PTAN",
            "identifier": "ZZZ26433Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.