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1174190672
JACOB NICOLAS TICE
SAN DIEGO, CA
NPI
1174190672
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: CA DDS106187)
Enumeration Date
2021-06-04
Last Update Date
2021-06-04
Business Address
Dr. JACOB NICOLAS TICE DMD
1975 GARNET AVE STE E
SAN DIEGO, CA 92109-3594
Phone number: 858-866-0808
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Mailing Address
Dr. JACOB NICOLAS TICE DMD
7117 EL VIENTO WAY
BUENA PARK, CA 90620-2510
Phone number: 480-302-1467
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