Provider Demographics
NPI:1558433748
Name:ISAACSON, DANA JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:JOHN
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 W OLD SHAKOPEE RD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2976
Mailing Address - Country:US
Mailing Address - Phone:952-881-8404
Mailing Address - Fax:952-881-9520
Practice Address - Street 1:4200 W OLD SHAKOPEE RD
Practice Address - Street 2:SUITE 223
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2976
Practice Address - Country:US
Practice Address - Phone:952-881-8404
Practice Address - Fax:952-881-9520
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN79771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice