Provider Demographics
NPI:1821078700
Name:NISHIMURA, ROGER SATORU JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:SATORU
Last Name:NISHIMURA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:311 NW RIDGEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6131
Mailing Address - Country:US
Mailing Address - Phone:580-353-4372
Mailing Address - Fax:
Practice Address - Street 1:1008 SW C AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4300
Practice Address - Country:US
Practice Address - Phone:580-248-6055
Practice Address - Fax:580-248-6056
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKENDODONTICS # 271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics