Provider Demographics
NPI:1235250291
Name:NAKAMITSU, NOLA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOLA
Middle Name:M
Last Name:NAKAMITSU
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 1:689 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2511
Mailing Address - Country:US
Mailing Address - Phone:650-326-1812
Mailing Address - Fax:650-326-1812
Practice Address - Street 1:689 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2511
Practice Address - Country:US
Practice Address - Phone:650-326-1812
Practice Address - Fax:650-326-1812
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice