Provider Demographics
NPI:1316092661
Name:SARATOGA PERIODONTICS & IMPLANTS
Entity type:Organization
Organization Name:SARATOGA PERIODONTICS & IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIMINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-378-2320
Mailing Address - Street 1:1888 SARATOGA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4161
Mailing Address - Country:US
Mailing Address - Phone:408-378-2320
Mailing Address - Fax:408-374-4610
Practice Address - Street 1:1888 SARATOGA AVE
Practice Address - Street 2:STE 100
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4161
Practice Address - Country:US
Practice Address - Phone:408-378-2320
Practice Address - Fax:408-374-4610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432181223P0300X
CA382841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty