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General NPI Number Information
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NPI Number | 1093865610
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Entity Type | Organization
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Legal Business Name | DAISY G. ISON, D.M.D., INC.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5345 N EL DORADO ST SUITE 2
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City | STOCKTON
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State | CA
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Zip | 95207-5872
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Country | US
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Telephone | 209-952-2933
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Fax | 209-952-2271
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Provider Business Mailing Address
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Address Line | 5345 N EL DORADO ST SUITE
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City | STOCKTON
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State | CA
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Zip | 95207-5872
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Country | US
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Telephone | 209-952-2933
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Fax | 209-952-2271
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAISY GONZAGA ISON
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Credential | DDS
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Telephone | 209-952-2933
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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 | 34120
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License Number State | CA
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