Provider Demographics
NPI:1437351053
Name:NISHIMURA, RUSSELL DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DEAN
Last Name:NISHIMURA
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 1:911 HAMPSHIRE ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2818
Mailing Address - Country:US
Mailing Address - Phone:805-496-0026
Mailing Address - Fax:805-496-0050
Practice Address - Street 1:911 HAMPSHIRE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2818
Practice Address - Country:US
Practice Address - Phone:805-496-0026
Practice Address - Fax:805-496-0050
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345321223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics