MEDICARE: NISHANO THOMAS DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	21579	TX

General Provider Information

NPI Number	:	1861860652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NISHANO THOMAS DMD PA

Provider Business Mailing Address
First Line	:	6010 WASHINGTON AVE
Second Line	:	SUITE D
City	:	HOUSTON
State	:	TX
Zip	:	77007-5390
Country	:	US
Telephone Number	:	713-864-3800
Fax Number	:	713-864-3882

Provider Business Practice Location Address
First Line	:	6010 WASHINGTON AVE
Second Line	:	SUITE D
City	:	HOUSTON
State	:	TX
Zip	:	77007-5390
Country	:	US
Telephone Number	:	713-864-3800
Fax Number	:	713-864-3882

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NISHANO THOMAS
Credential	:	DMD
Telephone Number	:	713-864-3800

Provider Enumeration Date	:	09/10/2015
Last Update Date	:	09/10/2015

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