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General NPI Number Information
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NPI Number | 1659789865
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Entity Type | Organization
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Legal Business Name | HIROSHI HIRAYAMA DMD LLC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 745 BOYLSTON ST
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City | BOSTON
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State | MA
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Zip | 02116-2636
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Country | US
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Telephone | 617-536-3054
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Fax |
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Provider Business Mailing Address
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Address Line | 134 WALNUT HILL RD
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City | NEWTON HIGHLANDS
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State | MA
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Zip | 02461-1837
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Country | US
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Telephone | 617-536-3054
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HIROSHI HIRAYAMA
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Credential | DMD
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Telephone | 617-536-3054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 18149
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License Number State | MA
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