Provider Demographics
NPI:1205987641
Name:YAMAMOTO, HIDEO (DMD)
Entity type:Individual
Prefix:DR
First Name:HIDEO
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CENTRE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2454
Mailing Address - Country:US
Mailing Address - Phone:617-964-0063
Mailing Address - Fax:617-964-4913
Practice Address - Street 1:1400 CENTRE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2454
Practice Address - Country:US
Practice Address - Phone:617-964-0063
Practice Address - Fax:617-964-4913
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics