Provider Demographics
NPI:1700112877
Name:NISHINO, TATSUO PETER (DDS)
Entity Type:Individual
Prefix:
First Name:TATSUO
Middle Name:PETER
Last Name:NISHINO
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 1:1111 W ADOUE ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-2718
Mailing Address - Country:US
Mailing Address - Phone:281-824-1480
Mailing Address - Fax:281-220-6407
Practice Address - Street 1:2552 BROADWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4904
Practice Address - Country:US
Practice Address - Phone:281-824-1490
Practice Address - Fax:281-220-6407
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist