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General NPI Number Information
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NPI Number | 1649654898
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Entity Type | Individual
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Provider Name | CHRISTOPHER R. ISABELLE DMD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 1605 S MICHIGAN AVE SUITE B
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City | CHICAGO
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State | IL
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Zip | 60616-1209
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Country | US
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Telephone | 312-624-8913
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 S MICHIGAN AVE UNIT 716
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City | CHICAGO
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State | IL
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Zip | 60616-1281
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Country | US
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Telephone | 708-415-6507
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019030292
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License Number State | IL
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