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General NPI Number Information
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NPI Number | 1225531957
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Entity Type | Individual
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Provider Name | ISAAC SAMUEL TADDESSEE DDS
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Gender | Male
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 3500 OLD WASHINGTON RD STE 301
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City | WALDORF
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State | MD
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Zip | 20602-3225
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Country | US
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Telephone | 301-645-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 6009 BINGLEY RD
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City | ALEXANDRIA
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State | VA
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Zip | 22315-4838
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Country | US
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Telephone | 571-228-3417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DEN1002039
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401416686
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17043
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License Number State | MD
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