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General NPI Number Information
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NPI Number | 1871172726
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Entity Type | Organization
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Legal Business Name | ISAACSON DENTAL CENTER PLLC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 5270 W 84TH ST STE 360
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City | BLOOMINGTON
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State | MN
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Zip | 55437-1377
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Country | US
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Telephone | 612-281-6830
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Fax |
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Provider Business Mailing Address
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Address Line | 5270 W 84TH ST STE 360
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City | BLOOMINGTON
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State | MN
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Zip | 55437-1377
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Country | US
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Telephone | 612-281-6830
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Fax |
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | DR. TIMOTHY JOHN ISAACSON
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Credential | DDS
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Telephone | 612-281-6830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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