Provider Demographics
NPI:1932610664
Name:DAVID NISENBOYM, DDS, INC.
Entity Type:Organization
Organization Name:DAVID NISENBOYM, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NISENBOYM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-704-0974
Mailing Address - Street 1:1730 SACRAMENTO ST APT 10
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3671
Mailing Address - Country:US
Mailing Address - Phone:916-704-0974
Mailing Address - Fax:
Practice Address - Street 1:2439 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-2606
Practice Address - Country:US
Practice Address - Phone:415-334-1737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63382261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental