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NPI 1558488312

NPI 1558488312 : ROLAND NISHIOKA, DMD, INC. : PEARL CITY, HI

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General NPI Number Information
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    NPI Number           |    1558488312
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    Entity Type          |    Organization 
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    Legal Business Name  |    ROLAND NISHIOKA, DMD, INC. 
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Dates
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    Enumeration Date     |    03/24/2007
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    Last Update Date     |    08/22/2020
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Provider Practice Location Address
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    Address Line         |    719 KAMEHAMEHA HWY 
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    City                 |    PEARL CITY
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    State                |    HI
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    Zip                  |    96782-2709
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    Country              |    US
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    Telephone            |    808-455-3485
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    719 KAMEHAMEHA HWY 
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    City                 |    PEARL CITY
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    State                |    HI
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    Zip                  |    96782-2709
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    Country              |    US
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    Telephone            |    808-455-3485
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    Fax                  |    
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Authorized Official
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    Title or Position    |    PRESIDENT
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    Name                 |     ROLAND  NISHIOKA 
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    Credential           |    
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    Telephone            |    808-455-3485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    1391
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    License Number State |    HI
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