Provider Demographics
NPI:1043317183
Name:NICKHINSON, VAL (DDS)
Entity type:Individual
Prefix:DR
First Name:VAL
Middle Name:
Last Name:NICKHINSON
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 1:390 EL CAMINO REAL
Mailing Address - Street 2:SUITE # D
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2054
Mailing Address - Country:US
Mailing Address - Phone:650-631-2893
Mailing Address - Fax:650-631-2896
Practice Address - Street 1:390 EL CAMINO REAL
Practice Address - Street 2:SUITE # D
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2054
Practice Address - Country:US
Practice Address - Phone:650-631-2893
Practice Address - Fax:650-631-2896
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice