Provider Demographics
NPI:1225051113
Name:NISHIMURA, BRENDA JOYCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JOYCE
Last Name:NISHIMURA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JOHN BENSON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:781-274-0171
Mailing Address - Fax:
Practice Address - Street 1:922 WALTHAM ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421
Practice Address - Country:US
Practice Address - Phone:781-861-1444
Practice Address - Fax:781-861-6534
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice