Provider Demographics
NPI:1437684784
Name:NAKHLA DENTAL GROUP
Entity Type:Organization
Organization Name:NAKHLA DENTAL GROUP
Other - Org Name:CROW CANYON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-838-1533
Mailing Address - Street 1:CROW CANYON DENTAL
Mailing Address - Street 2:2821 CROW CANYON ROAD #200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-383-1533
Mailing Address - Fax:925-838-3146
Practice Address - Street 1:CROW CANYON DENTAL
Practice Address - Street 2:2821 CROW CANYON ROAD #200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-383-1533
Practice Address - Fax:925-838-3146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty