Provider Demographics
NPI:1558682286
Name:KARNEY, NICHOLAS JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JON
Last Name:KARNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 SNYDER LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2915
Mailing Address - Country:US
Mailing Address - Phone:716-997-6295
Mailing Address - Fax:
Practice Address - Street 1:5300 SNYDER LN
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2915
Practice Address - Country:US
Practice Address - Phone:716-997-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist