Healthcare Provider Details

I. General information

NPI: 1427309897
Provider Name (Legal Business Name): JENNIE ISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIE WILLIAMS MD

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

1010 MAIN ST S
MC KEE KY
40447-7089
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1761
  • Fax:
Mailing address:
  • Phone: 606-287-7104
  • Fax: 606-287-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number9196
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: