Provider Demographics
NPI:1548391154
Name:NISHIMURA, ROBIN MAMORU (DD,S)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:MAMORU
Last Name:NISHIMURA
Suffix:
Gender:M
Credentials:DD,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2656
Mailing Address - Country:US
Mailing Address - Phone:808-456-4552
Mailing Address - Fax:808-456-4553
Practice Address - Street 1:850 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 112
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2656
Practice Address - Country:US
Practice Address - Phone:808-456-4552
Practice Address - Fax:808-456-4553
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-15621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice