Provider Demographics
NPI:1093162935
Name:JOHN M NAKHLA DDS, INC
Entity Type:Organization
Organization Name:JOHN M NAKHLA DDS, INC
Other - Org Name:CASTRO VALLEY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-881-1611
Mailing Address - Street 1:20099 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4326
Mailing Address - Country:US
Mailing Address - Phone:510-881-1611
Mailing Address - Fax:510-881-0254
Practice Address - Street 1:20099 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4326
Practice Address - Country:US
Practice Address - Phone:510-881-1611
Practice Address - Fax:510-881-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty