MEDICARE: LISAL B. ISAACS, DMD, P.A.

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	7617	NC

General Provider Information

NPI Number	:	1881882710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISAL B. ISAACS, DMD, P.A.

Provider Business Mailing Address
First Line	:	603 NASH ST W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3059
Country	:	US
Telephone Number	:	252-291-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 NASH ST W
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3059
Country	:	US
Telephone Number	:	252-291-6313
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. LISAL B ISAACS
Credential	:	DMD
Telephone Number	:	252-291-6313

Provider Enumeration Date	:	10/04/2007
Last Update Date	:	10/04/2007

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