Healthcare Provider Details

I. General information

NPI: 1982396826
Provider Name (Legal Business Name): ISABEL CHRISTINE ILLINGWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S UNIVERSITY BLVD
MOBILE AL
36609-2923
US

IV. Provider business mailing address

801 S UNIVERSITY BLVD
MOBILE AL
36609-2923
US

V. Phone/Fax

Practice location:
  • Phone: 251-345-1717
  • Fax:
Mailing address:
  • Phone: 251-345-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD.007675-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: