MEDICARE: ISIS MASSOUD, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		MD

General Provider Information

NPI Number	:	1841538923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISIS MASSOUD, DDS

Provider Business Mailing Address
First Line	:	7063 ALLENTOWN RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-5301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7063 ALLENTOWN RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-5301
Country	:	US
Telephone Number	:	301-449-1088
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ISIS MASSOUD
Credential	:	DDS
Telephone Number	:	301-449-1088

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	01/23/2013

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Directions to “ISIS MASSOUD, DDS ” Practice Location

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