Healthcare Provider Details

I. General information

NPI: 1215635206
Provider Name (Legal Business Name): GEORGES ISAAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 S COLUMBIA ST
CHAPEL HILL NC
27514-4309
US

IV. Provider business mailing address

1500 LOCUST ST APT 3412
PHILADELPHIA PA
19102-4341
US

V. Phone/Fax

Practice location:
  • Phone: 919-537-3737
  • Fax:
Mailing address:
  • Phone: 469-835-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419736
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044194
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number39633
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03005600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: