Provider Demographics
NPI:1073870416
Name:ISSAC, ERIN MICHAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MICHAL
Last Name:ISSAC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 ELLSWORTH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1795
Mailing Address - Country:US
Mailing Address - Phone:412-404-2077
Mailing Address - Fax:412-404-7633
Practice Address - Street 1:5730 ELLSWORTH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1795
Practice Address - Country:US
Practice Address - Phone:412-404-2077
Practice Address - Fax:412-404-7633
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028147270001Medicaid