Provider Demographics
NPI:1467650374
Name:ISOM, ALICE JENNIFER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:JENNIFER
Last Name:ISOM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 NW 78TH AVE
Mailing Address - Street 2:104
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-0905
Mailing Address - Country:US
Mailing Address - Phone:954-254-0600
Mailing Address - Fax:
Practice Address - Street 1:900 N MIAMI BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3716
Practice Address - Country:US
Practice Address - Phone:305-947-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist