Provider Demographics
NPI:1821207655
Name:HASHIMOTO, LANCE KOJI (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:KOJI
Last Name:HASHIMOTO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16515 TIA CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-1371
Mailing Address - Country:US
Mailing Address - Phone:262-510-7002
Mailing Address - Fax:
Practice Address - Street 1:16650 W BLUEMOUND RD
Practice Address - Street 2:400
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5920
Practice Address - Country:US
Practice Address - Phone:262-782-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4054-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics