Provider Demographics
NPI:1467584961
Name:NISHIME, MICHAEL LEWELLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEWELLYN
Last Name:NISHIME
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 STE 212
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3258
Mailing Address - Country:US
Mailing Address - Phone:808-732-0291
Mailing Address - Fax:808-732-4092
Practice Address - Street 1:3660 WAIALAE AVE STE 212
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3258
Practice Address - Country:US
Practice Address - Phone:808-732-0291
Practice Address - Fax:808-732-4092
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist