Provider Demographics
NPI:1134122815
Name:NOMURA, PAMELA (DDS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:NOMURA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5100
Mailing Address - Country:US
Mailing Address - Phone:408-264-1917
Mailing Address - Fax:408-264-1918
Practice Address - Street 1:1660 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5100
Practice Address - Country:US
Practice Address - Phone:408-264-1917
Practice Address - Fax:408-264-1918
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
CA321551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice