Provider Demographics
NPI:1609872191
Name:NISHIKUBO, JON M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:NISHIKUBO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1171 MURRIETA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4143
Mailing Address - Country:US
Mailing Address - Phone:925-960-0990
Mailing Address - Fax:925-960-9977
Practice Address - Street 1:1171 MURRIETA BLVD
Practice Address - Street 2:STE 201
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4143
Practice Address - Country:US
Practice Address - Phone:925-960-0990
Practice Address - Fax:925-960-9977
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA457411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice