Provider Demographics
NPI:1558488312
Name:ROLAND NISHIOKA, DMD, INC.
Entity Type:Organization
Organization Name:ROLAND NISHIOKA, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-455-3485
Mailing Address - Street 1:719 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2709
Mailing Address - Country:US
Mailing Address - Phone:808-455-3485
Mailing Address - Fax:
Practice Address - Street 1:719 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2709
Practice Address - Country:US
Practice Address - Phone:808-455-3485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty