MEDICARE: DR. JASON W ISAACSON DDS

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	1223G0001X	General Practice Dentistry	6592	WI

General Provider Information

NPI Number	:	1588892368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON W ISAACSON DDS

Provider Business Mailing Address
First Line	:	2901 PIONEER AVE
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-2434
Country	:	US
Telephone Number	:	715-609-2461
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 PIONEER AVE
Second Line	:
City	:	RICE LAKE
State	:	WI
Zip	:	54868-2434
Country	:	US
Telephone Number	:	715-609-2461
Fax Number	:

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/02/2022

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