Provider Demographics
NPI:1912158569
Name:ISHIGAKI, MIDORIKO (DMD)
Entity type:Individual
Prefix:DR
First Name:MIDORIKO
Middle Name:
Last Name:ISHIGAKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 UNION ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2252
Mailing Address - Country:US
Mailing Address - Phone:617-244-6010
Mailing Address - Fax:617-244-6011
Practice Address - Street 1:69 UNION ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2252
Practice Address - Country:US
Practice Address - Phone:617-244-6010
Practice Address - Fax:617-244-6011
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist