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General NPI Number Information
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NPI Number | 1962871483
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Entity Type | Organization
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Legal Business Name | BLAKE ISHIKAWA, LLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 410 KILANI AVE #221
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City | WAHIAWA
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State | HI
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Zip | 96786-1844
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Country | US
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Telephone | 808-622-4354
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Fax |
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Provider Business Mailing Address
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Address Line | 3566 TROUSSEAU ST
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City | HONOLULU
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State | HI
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Zip | 96815-4353
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Country | US
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Telephone | 808-561-0955
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. BLAKE C ISHIKAWA
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Credential | DDS
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Telephone | 808-561-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DT2409
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License Number State | HI
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