MEDICARE: MS. ALLYSON ISENHOWER DMD

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	2023026137	MO
2	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1902599160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLYSON ISENHOWER DMD

Provider Business Mailing Address
First Line	:	1457 LINDEN LN
Second Line	:
City	:	TRENTON
State	:	IL
Zip	:	62293-2832
Country	:	US
Telephone Number	:	618-978-7852
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 S HANLEY RD UNIT 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2902
Country	:	US
Telephone Number	:	314-862-2006
Fax Number	:

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	07/05/2023

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