Provider Demographics
NPI:1881737435
Name:RUSSELL L. NAKANO, D.D.S., INC.
Entity type:Organization
Organization Name:RUSSELL L. NAKANO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAKANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-245-2831
Mailing Address - Street 1:665 S KNICKERBOCKER DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1033
Mailing Address - Country:US
Mailing Address - Phone:408-245-2831
Mailing Address - Fax:
Practice Address - Street 1:665 S KNICKERBOCKER DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1033
Practice Address - Country:US
Practice Address - Phone:408-245-2831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty