1235393273 NPI number — DR. NICKLAUS ALAN MORTON D.D.S, M.S.

Table of content: KODUVATHARA L JAMES MD (NPI 1063400885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235393273 NPI number — DR. NICKLAUS ALAN MORTON D.D.S, M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORTON
Provider First Name:
NICKLAUS
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S, M.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235393273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 BERRY ST
Provider Second Line Business Mailing Address:
#408
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94158-1567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-361-8507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2991 TREAT BLVD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94518-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-686-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  59294 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223E0200X , with the licence number: RESIDENT PERMIT #677 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)