Provider Demographics
NPI:1154694503
Name:NAKAMURA, KIYOHIKO (DDS)
Entity type:Individual
Prefix:
First Name:KIYOHIKO
Middle Name:
Last Name:NAKAMURA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:SUITE 32-228
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:212-687-6185
Mailing Address - Fax:
Practice Address - Street 1:30 E 60TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1008
Practice Address - Country:US
Practice Address - Phone:212-687-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0482421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice