Provider Demographics
NPI:1184912693
Name:NAKHLA, JOHN M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:NAKHLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2821 CROW CANYON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1659
Mailing Address - Country:US
Mailing Address - Phone:925-837-8765
Mailing Address - Fax:925-837-1660
Practice Address - Street 1:2821 CROW CANYON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1659
Practice Address - Country:US
Practice Address - Phone:925-837-8765
Practice Address - Fax:925-837-1660
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA605011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice