MEDICARE: DR. ALICE JENNIFER ISOM D.M.D.

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	122300000X	Dentist	DN17622	FL

General Provider Information

NPI Number	:	1467650374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICE JENNIFER ISOM D.M.D.

Provider Business Mailing Address
First Line	:	2170 NW 78TH AVE
Second Line	:	104
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-0905
Country	:	US
Telephone Number	:	954-254-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 N MIAMI BEACH BLVD
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3716
Country	:	US
Telephone Number	:	305-947-9001
Fax Number	:

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

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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