Provider Demographics
NPI:1275666356
Name:NAKAMOTO, CLIFFORD (DDS)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:NAKAMOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 TELEGRAPH AVENUE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2030
Mailing Address - Country:US
Mailing Address - Phone:510-845-1931
Mailing Address - Fax:
Practice Address - Street 1:2915 TELEGRAPH AVENUE
Practice Address - Street 2:SUITE 302
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2030
Practice Address - Country:US
Practice Address - Phone:510-845-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice