Provider Demographics
NPI:1023118247
Name:NAKANO, RONALD A (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:NAKANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 KIELY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5744
Mailing Address - Country:US
Mailing Address - Phone:408-248-0168
Mailing Address - Fax:408-248-6490
Practice Address - Street 1:785 KIELY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5744
Practice Address - Country:US
Practice Address - Phone:408-248-0168
Practice Address - Fax:408-248-6490
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice