Provider Demographics
NPI:1659589075
Name:ISLER, MARK STUART (DDS MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STUART
Last Name:ISLER
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41491 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2896
Mailing Address - Country:US
Mailing Address - Phone:248-761-9457
Mailing Address - Fax:
Practice Address - Street 1:41491 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2896
Practice Address - Country:US
Practice Address - Phone:248-761-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019162122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist