Provider Demographics
NPI:1497295968
Name:BLAIR A ISOM DDS LTD
Entity Type:Organization
Organization Name:BLAIR A ISOM DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-645-1323
Mailing Address - Street 1:7180 CASCADE VALLEY CT STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1407
Mailing Address - Country:US
Mailing Address - Phone:702-645-1323
Mailing Address - Fax:702-645-8807
Practice Address - Street 1:7180 CASCADE VALLEY CT STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1407
Practice Address - Country:US
Practice Address - Phone:702-645-1323
Practice Address - Fax:702-645-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty