Provider Demographics
NPI:1376294199
Name:EMPSON, ISAAC R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:R
Last Name:EMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 N PARLIAMENT PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1632
Mailing Address - Country:US
Mailing Address - Phone:309-922-6995
Mailing Address - Fax:
Practice Address - Street 1:1101 S AIRLINE RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3888
Practice Address - Country:US
Practice Address - Phone:262-833-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist