Healthcare Provider Details

I. General information

NPI: 1588892368
Provider Name (Legal Business Name): JASON W ISAACSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 PIONEER AVE
RICE LAKE WI
54868-2434
US

IV. Provider business mailing address

2901 PIONEER AVE
RICE LAKE WI
54868-2434
US

V. Phone/Fax

Practice location:
  • Phone: 715-609-2461
  • Fax:
Mailing address:
  • Phone: 715-609-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6592
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: