Provider Demographics
NPI:1003122656
Name:ISAAC, KANYARATANA (DDS)
Entity Type:Individual
Prefix:
First Name:KANYARATANA
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3409
Mailing Address - Country:US
Mailing Address - Phone:850-767-3350
Mailing Address - Fax:850-767-3353
Practice Address - Street 1:403 E 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3409
Practice Address - Country:US
Practice Address - Phone:850-767-3350
Practice Address - Fax:850-767-3353
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice