Provider Demographics
NPI:1205039245
Name:ISHIKAWA, SHOUN N (DMD)
Entity type:Individual
Prefix:DR
First Name:SHOUN
Middle Name:N
Last Name:ISHIKAWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 SW MULTNOMAH BLVD.
Mailing Address - Street 2:SUITE H
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-246-2111
Mailing Address - Fax:503-246-9827
Practice Address - Street 1:2350 SW MULTNOMAH BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3999
Practice Address - Country:US
Practice Address - Phone:503-246-2111
Practice Address - Fax:503-246-9827
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD41351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice