Provider Demographics
NPI:1659789865
Name:HIROSHI HIRAYAMA DMD LLC
Entity Type:Organization
Organization Name:HIROSHI HIRAYAMA DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIROSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-536-3054
Mailing Address - Street 1:134 WALNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1837
Mailing Address - Country:US
Mailing Address - Phone:617-536-3054
Mailing Address - Fax:
Practice Address - Street 1:745 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2636
Practice Address - Country:US
Practice Address - Phone:617-536-3054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1790834463OtherNPI TYPE 1