Healthcare Provider Details

I. General information

NPI: 1689149320
Provider Name (Legal Business Name): ISON NOLL ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 RIALTO RD STE A
WEST CHESTER OH
45069-2910
US

IV. Provider business mailing address

4845 RIALTO RD STE A
WEST CHESTER OH
45069-2910
US

V. Phone/Fax

Practice location:
  • Phone: 513-772-6500
  • Fax: 513-772-2002
Mailing address:
  • Phone: 513-772-6500
  • Fax: 513-772-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KEVIN J ISON
Title or Position: CO-OWNER
Credential: DMD, MS
Phone: 513-772-6500