Provider Demographics
NPI:1497786966
Name:NISHIMOTO, DORIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:NISHIMOTO
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 1:78 N ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2820
Mailing Address - Country:US
Mailing Address - Phone:650-344-1844
Mailing Address - Fax:650-344-1844
Practice Address - Street 1:320 N SAN MATEO DR # 2
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2514
Practice Address - Country:US
Practice Address - Phone:650-344-1844
Practice Address - Fax:650-344-1844
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA275491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice