Provider Demographics
NPI:1609850437
Name:NISHIMURA, STANLEY KAZUO (DDS)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:KAZUO
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 1:4100 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1262
Mailing Address - Country:US
Mailing Address - Phone:425-747-8888
Mailing Address - Fax:425-564-8562
Practice Address - Street 1:4100 FACTORIA BLVD SE
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1262
Practice Address - Country:US
Practice Address - Phone:425-747-8888
Practice Address - Fax:425-564-8562
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 0000 7297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist