Provider Demographics
NPI:1326267451
Name:ISOM, BLAIR ABBOTT (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:ABBOTT
Last Name:ISOM
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:702-645-1323
Mailing Address - Fax:702-870-7058
Practice Address - Street 1:500 N. RAINBOW BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1085
Practice Address - Country:US
Practice Address - Phone:702-645-1323
Practice Address - Fax:702-645-8807
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice