Healthcare Provider Details

I. General information

NPI: 1861541245
Provider Name (Legal Business Name): JAMES A NADOLNY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2234 CHANNING WAY
BERKELEY CA
94704
US

IV. Provider business mailing address

2234 CHANNING WAY
BERKELEY CA
94704
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8900
  • Fax: 510-548-8910
Mailing address:
  • Phone: 510-548-8900
  • Fax: 510-548-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: