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General NPI Number Information
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NPI Number | 1881737435
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Entity Type | Organization
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Legal Business Name | RUSSELL L. NAKANO, D.D.S., INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 665 S KNICKERBOCKER DR SUITE 6
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City | SUNNYVALE
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State | CA
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Zip | 94087-1033
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Country | US
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Telephone | 408-245-2831
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Fax |
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Provider Business Mailing Address
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Address Line | 665 S KNICKERBOCKER DR SUITE 6
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City | SUNNYVALE
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State | CA
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Zip | 94087-1033
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Country | US
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Telephone | 408-245-2831
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSELL L. NAKANO
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Credential | D.D.S.
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Telephone | 408-245-2831
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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 | 23546
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License Number State | CA
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