Active NPI
David Nisenboym, DDS
- Dentist
- Walnut Creek, CA
National Provider Identifier
1821425166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 63382
- Practice address
- 130 Petticoat LN
Walnut Creek, CA 94596-5017 - Phone
- (916) 704-0974
- NPI assigned
- Oct 1, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 63382 | CA | Primary |
Addresses
Primary practice location
130 Petticoat LN
Walnut Creek, CA 94596-5017
Mailing address
130 Petticoat LN
Walnut Creek, CA 94596-5017
Phone (916) 704-0974
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63382 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640822400000",
"number": "1821425166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 PETTICOAT LN",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945965017",
"telephone_number": "916-704-0974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 PETTICOAT LN",
"city": "WALNUT CREEK",
"state": "CA",
"postal_code": "945965017",
"telephone_number": "916-704-0974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISENBOYM",
"first_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-10-01",
"last_updated": "2021-12-30",
"certification_date": "2021-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "63382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Walnut Creek, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.