Provider Demographics
NPI:1629209630
Name:ISAZA, EMILIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILIA
Middle Name:
Last Name:ISAZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S. DIXIE HWY
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460
Mailing Address - Country:US
Mailing Address - Phone:561-202-9190
Mailing Address - Fax:
Practice Address - Street 1:325 S. DIXIE HWY
Practice Address - Street 2:SUITE #5
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460
Practice Address - Country:US
Practice Address - Phone:561-202-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist