Provider Demographics
NPI:1912565151
Name:NICHOLAS TJ YATCO DDS INC
Entity Type:Organization
Organization Name:NICHOLAS TJ YATCO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:TJ
Authorized Official - Last Name:YATCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-386-9176
Mailing Address - Street 1:20600 LAKE CHABOT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5432
Mailing Address - Country:US
Mailing Address - Phone:510-581-4124
Mailing Address - Fax:
Practice Address - Street 1:20600 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5432
Practice Address - Country:US
Practice Address - Phone:510-581-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental