Provider Demographics
NPI:1629480066
Name:GORDON R ISBELL, III, DMD, PA
Entity Type:Organization
Organization Name:GORDON R ISBELL, III, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:ROSWELL
Authorized Official - Last Name:ISBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD, PA
Authorized Official - Phone:256-547-3589
Mailing Address - Street 1:241 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4213
Mailing Address - Country:US
Mailing Address - Phone:256-547-3589
Mailing Address - Fax:256-543-2929
Practice Address - Street 1:241 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4213
Practice Address - Country:US
Practice Address - Phone:256-547-3589
Practice Address - Fax:256-543-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1891748281OtherNPPES
AL1952667230OtherNPPES