=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598572828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISAAC P. ZISBLATT DMD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2024
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 CHURCH AVE STE 101
-----------------------------------------------------
City | WAREHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02571-2093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-295-3388
-----------------------------------------------------
Fax | 508-295-3289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 CHURCH AVE STE 101
-----------------------------------------------------
City | WAREHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02571-2093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-295-3388
-----------------------------------------------------
Fax | 508-295-3289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. ISAAC P ZISBLATT
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 508-527-6507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------