=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770848145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY MICHELLE ISBLE DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2012
-----------------------------------------------------
Last Update Date | 07/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 FLORIDA ST
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25302-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-348-6613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 7TH AVE
-----------------------------------------------------
City | SAINT ALBANS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25177-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-722-5930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4004
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------