Provider Demographics
NPI:1326591223
Name:ISSAC, SAIF
Entity Type:Individual
Prefix:
First Name:SAIF
Middle Name:
Last Name:ISSAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:08806-1913
Mailing Address - Country:US
Mailing Address - Phone:203-696-3260
Mailing Address - Fax:203-696-3269
Practice Address - Street 1:982 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:08806
Practice Address - Country:US
Practice Address - Phone:203-696-3260
Practice Address - Fax:203-696-3269
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4589122300000X
CT123431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist