Provider Demographics
NPI:1487784989
Name:WATANABE, HIDEHIKO (DDS, MS)
Entity type:Individual
Prefix:
First Name:HIDEHIKO
Middle Name:
Last Name:WATANABE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLLEGE OF DENTISTRY
Mailing Address - Street 2:40TH AND HOLDREGE STS. RM 137
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0740
Mailing Address - Country:US
Mailing Address - Phone:402-472-8900
Mailing Address - Fax:
Practice Address - Street 1:COLLEGE OF DENTISTRY
Practice Address - Street 2:40TH AND HOLDREGE STS. RM 137
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0740
Practice Address - Country:US
Practice Address - Phone:402-472-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-078998500Medicaid
NE4605OtherBC/BS