Provider Demographics
NPI:1386037570
Name:NISHIMOTO, RODNEY NAKANO (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:NAKANO
Last Name:NISHIMOTO
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-22040204E00000X
HIDT-2883204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery