Healthcare Provider Details

I. General information

NPI: 1619971413
Provider Name (Legal Business Name): PAUL E ISAACSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 4TH AVE E STE A
OLYMPIA WA
98506-4018
US

IV. Provider business mailing address

1105 4TH AVE E STE A
OLYMPIA WA
98506-4018
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-8075
  • Fax: 360-357-3842
Mailing address:
  • Phone: 360-357-8075
  • Fax: 360-357-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00006321
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00006321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: