Provider Demographics
NPI:1164436176
Name:ISAACSON, SUSAN JANIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JANIE
Last Name:ISAACSON
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 1:2112 3RD AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2310
Mailing Address - Country:US
Mailing Address - Phone:206-443-1788
Mailing Address - Fax:206-443-1790
Practice Address - Street 1:2112 3RD AVE STE 404
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2310
Practice Address - Country:US
Practice Address - Phone:206-443-1788
Practice Address - Fax:206-443-1790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice