| NPI | 1093909558 |
|---|---|
| Doing Business As | ISA DENTAL |
| Entity Type | Organization |
| Authorized Contact | JEFFREY CHARLES JOHNSON General Partner 671-646-7982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GU D 829) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GU D 901) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2007-08-28 |