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General NPI Number Information
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NPI Number | 1316520984
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Entity Type | Individual
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Provider Name | TOSHIHARU ICHIKAWA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 1989 NY-52
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533
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Country | US
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Telephone | 845-896-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 25 OLD MILL RD
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City | NEW PALTZ
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State | NY
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Zip | 12561-1317
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Country | US
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Telephone | 646-678-1652
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 062445-01
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License Number State | NY
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