Provider Demographics
NPI:1255643367
Name:NASAKIN, MIKHAIL (DDS)
Entity type:Individual
Prefix:DR
First Name:MIKHAIL
Middle Name:
Last Name:NASAKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:NASAKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2421 PARK BLVD
Mailing Address - Street 2:SUITE A200
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1998
Mailing Address - Country:US
Mailing Address - Phone:650-325-2457
Mailing Address - Fax:
Practice Address - Street 1:2421 PARK BLVD
Practice Address - Street 2:SUITE A200
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1998
Practice Address - Country:US
Practice Address - Phone:650-325-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist