Provider Demographics
NPI:1982896163
Name:MICHAEL J NELSON DDS PATRICIA L YOSHIDA DDS INC
Entity Type:Organization
Organization Name:MICHAEL J NELSON DDS PATRICIA L YOSHIDA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-471-9560
Mailing Address - Street 1:365 S RANCHO SANTA FE RD
Mailing Address - Street 2:#105
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2338
Mailing Address - Country:US
Mailing Address - Phone:760-471-9560
Mailing Address - Fax:
Practice Address - Street 1:365 S RANCHO SANTA FE RD
Practice Address - Street 2:#105
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2338
Practice Address - Country:US
Practice Address - Phone:760-471-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty