Provider Demographics
NPI:1689795643
Name:NAKAMITSU, LANCE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:H
Last Name:NAKAMITSU
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 1:1131 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1302
Mailing Address - Country:US
Mailing Address - Phone:650-589-1770
Mailing Address - Fax:650-615-0781
Practice Address - Street 1:1131 MISSION RD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-1302
Practice Address - Country:US
Practice Address - Phone:650-589-1770
Practice Address - Fax:650-615-0781
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice