Provider Demographics
NPI:1245241868
Name:NISHIGUCHI, KURT I (DDS)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:I
Last Name:NISHIGUCHI
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 1:3660 WAIALAE AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3257
Mailing Address - Country:US
Mailing Address - Phone:808-733-7000
Mailing Address - Fax:808-733-6900
Practice Address - Street 1:3660 WAIALAE AVE
Practice Address - Street 2:STE. 202
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3257
Practice Address - Country:US
Practice Address - Phone:808-733-7000
Practice Address - Fax:808-733-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice