Provider Demographics
NPI:1083674253
Name:ISACKSON, DEANN W (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DEANN
Middle Name:W
Last Name:ISACKSON
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55129
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-0129
Mailing Address - Country:US
Mailing Address - Phone:360-435-6072
Mailing Address - Fax:360-435-6172
Practice Address - Street 1:10907 SE 66TH ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1008
Practice Address - Country:US
Practice Address - Phone:360-435-6072
Practice Address - Fax:360-435-6172
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005443174400000X
WAMD00033148207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist