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General NPI Number Information
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NPI Number | 1083575492
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Entity Type | Organization
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Legal Business Name | BLACK BEAR DENTAL LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 2901 PIONEER AVE
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City | RICE LAKE
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State | WI
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Zip | 54868-2434
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Country | US
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Telephone | 715-609-2461
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Fax | 920-626-6377
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Provider Business Mailing Address
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Address Line | 2901 PIONEER AVE
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City | RICE LAKE
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State | WI
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Zip | 54868-2434
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Country | US
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Telephone | 715-609-2461
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Fax | 920-626-6377
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JASON WILLIAM ISAACSON
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Credential | DDS
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Telephone | 715-609-2461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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