Provider Demographics
NPI:1528787348
Name:WAROUNTHORN, NICHOLAS NAKARIN (DDS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:NAKARIN
Last Name:WAROUNTHORN
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 1:14689 VALLEY CENTER DR STE E101
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4200
Mailing Address - Country:US
Mailing Address - Phone:760-245-0151
Mailing Address - Fax:
Practice Address - Street 1:11346 MOUNTAIN VIEW AVE STE D
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3833
Practice Address - Country:US
Practice Address - Phone:909-796-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1077621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice