Provider Demographics
NPI:1831240399
Name:FENSTERMACHER, NANCY RUTLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:RUTLEY
Last Name:FENSTERMACHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2060
Mailing Address - Country:US
Mailing Address - Phone:510-841-0108
Mailing Address - Fax:510-841-7314
Practice Address - Street 1:2915 TELEGRAPH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2060
Practice Address - Country:US
Practice Address - Phone:510-841-0108
Practice Address - Fax:510-841-7314
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist