Provider Demographics
NPI:1083026884
Name:ISAACS, KYLE (RDHEP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:ISAACS
Suffix:
Gender:F
Credentials:RDHEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24386 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OR
Mailing Address - Zip Code:97456-9745
Mailing Address - Country:US
Mailing Address - Phone:541-740-4694
Mailing Address - Fax:
Practice Address - Street 1:24386 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OR
Practice Address - Zip Code:97456-9745
Practice Address - Country:US
Practice Address - Phone:541-740-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6618124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist