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General NPI Number Information
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NPI Number | 1750270757
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Entity Type | Individual
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Provider Name | SEIYA ISHIKURA DMD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 133 MARKET ST
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City | LOWELL
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State | MA
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Zip | 01852-6249
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Country | US
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Telephone | 978-458-1179
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Fax |
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Provider Business Mailing Address
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Address Line | 122 DRUMLIN HILL RD
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City | BOLTON
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State | MA
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Zip | 01740-2023
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Country | US
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Telephone | 978-333-3118
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN10001030
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License Number State | MA
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