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General NPI Number Information
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NPI Number | 1912565151
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Entity Type | Organization
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Legal Business Name | NICHOLAS TJ YATCO DDS INC
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 20600 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5432
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Country | US
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Telephone | 510-581-4124
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Fax |
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Provider Business Mailing Address
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Address Line | 20600 LAKE CHABOT RD STE 103
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5432
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Country | US
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Telephone | 510-581-4124
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NICHOLAS TJ YATCO
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Credential | DDS
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Telephone | 510-386-9176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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