Provider Demographics
NPI:1801207519
Name:GORGANI, NICK (DDS, MS)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:GORGANI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:731 ALTOS OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5402
Mailing Address - Country:US
Mailing Address - Phone:650-948-6884
Mailing Address - Fax:650-948-7244
Practice Address - Street 1:731 ALTOS OAKS DR
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5402
Practice Address - Country:US
Practice Address - Phone:650-948-6884
Practice Address - Fax:650-948-7244
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA381011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry