Provider Demographics
NPI:1770691545
Name:HASHIMOTO, WALTER WATARU (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WATARU
Last Name:HASHIMOTO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:WALTER
Other - Middle Name:W
Other - Last Name:HASHIMOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:38080 MARTHA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3809
Mailing Address - Country:US
Mailing Address - Phone:510-797-7010
Mailing Address - Fax:510-494-9454
Practice Address - Street 1:38080 MARTHA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3809
Practice Address - Country:US
Practice Address - Phone:510-797-7010
Practice Address - Fax:510-494-9454
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB16356OtherDENTICAL