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General NPI Number Information
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NPI Number | 1760201784
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Entity Type | Organization
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Legal Business Name | THOMAS G ISON DMD LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 8966 RUFFIAN LN
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City | NEWBURGH
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State | IN
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Zip | 47630-3424
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Country | US
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Telephone | 812-490-8070
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Fax | 812-490-8072
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Provider Business Mailing Address
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Address Line | 8966 RUFFIAN LN
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City | NEWBURGH
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State | IN
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Zip | 47630-3424
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Country | US
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Telephone | 812-490-8070
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Fax | 812-490-8072
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | THOMAS G ISON
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Credential | DMD
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Telephone | 812-490-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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