Provider Demographics
NPI:1326183914
Name:NAKANO, RUSSELL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:L
Last Name:NAKANO
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 1:665 S KNICKERBOCKER DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1033
Mailing Address - Country:US
Mailing Address - Phone:408-245-2831
Mailing Address - Fax:
Practice Address - Street 1:665 S KNICKERBOCKER DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1033
Practice Address - Country:US
Practice Address - Phone:408-245-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice