Provider Demographics
NPI:1427128263
Name:MAEHARA, NOLAN YUKITO (DDS)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:YUKITO
Last Name:MAEHARA
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 1:3655 LOMITA BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3931
Mailing Address - Country:US
Mailing Address - Phone:310-303-3860
Mailing Address - Fax:310-303-3868
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3931
Practice Address - Country:US
Practice Address - Phone:310-303-3860
Practice Address - Fax:310-303-3868
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice