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General NPI Number Information
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NPI Number | 1346652708
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Entity Type | Organization
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Legal Business Name | ISKOL & FISK LLC
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 747 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4317
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Country | US
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Telephone | 770-995-0538
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Fax | 770-962-3245
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Provider Business Mailing Address
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Address Line | 747 OLD NORCROSS RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4317
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Country | US
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Telephone | 770-995-0538
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Fax | 770-962-3245
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. GARY K ISKOL
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Credential | DDS
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Telephone | 770-995-0538
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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 | DN014058
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License Number State | GA
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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 | DN009877
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License Number State | GA
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