Healthcare Provider Details

I. General information

NPI: 1124026471
Provider Name (Legal Business Name): ISAAC A. HOUSE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HIGHWAY 80
HAUGHTON LA
71037-9419
US

IV. Provider business mailing address

4700 HIGHWAY 80
HAUGHTON LA
71037-9419
US

V. Phone/Fax

Practice location:
  • Phone: 318-949-9878
  • Fax: 318-949-3400
Mailing address:
  • Phone: 318-949-9878
  • Fax: 318-949-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3975
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: