Provider Demographics
NPI:1427277870
Name:BAN, NIKOLA J (DDS)
Entity type:Individual
Prefix:DR
First Name:NIKOLA
Middle Name:J
Last Name:BAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:J
Other - Last Name:BAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10723 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2312
Mailing Address - Country:US
Mailing Address - Phone:818-760-8108
Mailing Address - Fax:818-760-4356
Practice Address - Street 1:10723 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2312
Practice Address - Country:US
Practice Address - Phone:818-760-8108
Practice Address - Fax:818-760-4356
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice