Provider Demographics
NPI:1346327616
Name:DAVIDSON, ISABEL SOSA (RDH)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:SOSA
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 E LEAF RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-3184
Mailing Address - Country:US
Mailing Address - Phone:480-277-7464
Mailing Address - Fax:
Practice Address - Street 1:4355 E UNIVERSITY DR
Practice Address - Street 2:STE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7000
Practice Address - Country:US
Practice Address - Phone:480-830-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH5653124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist