Provider Demographics
NPI:1720478118
Name:HIDEMI TAKEZAWA DDS
Entity Type:Organization
Organization Name:HIDEMI TAKEZAWA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIDEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKEZAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-225-2545
Mailing Address - Street 1:692 TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2931
Mailing Address - Country:US
Mailing Address - Phone:201-225-2545
Mailing Address - Fax:
Practice Address - Street 1:692 TRENTON ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2931
Practice Address - Country:US
Practice Address - Phone:201-225-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025213001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty