MEDICARE: BLAIR A ISOM DDS LTD

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	2260	NV

General Provider Information

NPI Number	:	1497295968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAIR A ISOM DDS LTD

Provider Business Mailing Address
First Line	:	7180 CASCADE VALLEY CT STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1407
Country	:	US
Telephone Number	:	702-645-1323
Fax Number	:	702-645-8807

Provider Business Practice Location Address
First Line	:	7180 CASCADE VALLEY CT STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1407
Country	:	US
Telephone Number	:	702-645-1323
Fax Number	:	702-645-8807

Authorized Official
Title or Position	:	OWNER
Name	:	BLAIR A ISOM
Credential	:	DDS
Telephone Number	:	702-645-1323

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	03/03/2017

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