Healthcare Provider Details

I. General information

NPI: 1487784989
Provider Name (Legal Business Name): HIDEHIKO WATANABE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLLEGE OF DENTISTRY 40TH AND HOLDREGE STS. RM 137
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

COLLEGE OF DENTISTRY 40TH AND HOLDREGE STS. RM 137
LINCOLN NE
68583-0740
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-8900
  • Fax:
Mailing address:
  • Phone: 402-472-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number107
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: