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General NPI Number Information
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NPI Number | 1770789810
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Entity Type | Organization
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Legal Business Name | NAKAMURA & MITOMA DDS INC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1552 N TRACY BLVD
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City | TRACY
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State | CA
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Zip | 95376-2903
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Country | US
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Telephone | 209-835-9111
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Fax | 209-835-9169
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Provider Business Mailing Address
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Address Line | 1552 N TRACY BLVD
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City | TRACY
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State | CA
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Zip | 95376-2903
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Country | US
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Telephone | 209-835-9111
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Fax | 209-835-9169
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISLENA N THRASHER
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Credential | RDA
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Telephone | 209-835-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43850
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License Number State | CA
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