MEDICARE: DR. ISAAC FORDJOUR D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS2546	TN

General Provider Information

NPI Number	:	1013905165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAAC FORDJOUR D.D.S.

Provider Business Mailing Address
First Line	:	910 MADISON AVE
Second Line	:	SUITE 710
City	:	MEMPHIS
State	:	TN
Zip	:	38103-3403
Country	:	US
Telephone Number	:	901-526-3988
Fax Number	:	901-526-9807

Provider Business Practice Location Address
First Line	:	910 MADISON AVE
Second Line	:	SUITE 710
City	:	MEMPHIS
State	:	TN
Zip	:	38103-3403
Country	:	US
Telephone Number	:	901-526-3988
Fax Number	:	901-526-9807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	06/24/2014

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