Provider Demographics
NPI:1225619505
Name:RODNEY N. NISHIMOTO, DMD, MD, LLC
Entity Type:Organization
Organization Name:RODNEY N. NISHIMOTO, DMD, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:NAKANO
Authorized Official - Last Name:NISHIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:808-739-5678
Mailing Address - Street 1:900 PUNAHOU ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2500
Mailing Address - Country:US
Mailing Address - Phone:808-949-8681
Mailing Address - Fax:808-949-2488
Practice Address - Street 1:900 PUNAHOU ST STE 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2500
Practice Address - Country:US
Practice Address - Phone:808-949-8681
Practice Address - Fax:808-949-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-18
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty