Provider Demographics
NPI:1003028036
Name:ISAACS, JOHN T JR (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:ISAACS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CARDINAL DR
Mailing Address - Street 2:PO BOX 447
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1520
Mailing Address - Country:US
Mailing Address - Phone:859-336-5131
Mailing Address - Fax:
Practice Address - Street 1:39 BOBOLINK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1516
Practice Address - Country:US
Practice Address - Phone:859-336-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice