Provider Demographics
NPI:1659785715
Name:ISAIA, FEDERICA
Entity Type:Individual
Prefix:MRS
First Name:FEDERICA
Middle Name:
Last Name:ISAIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KNEELAND ST
Mailing Address - Street 2:TUFTS DENTAL SCHOOL - PERIO
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6531
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND ST
Practice Address - Street 2:TUFTS DENTAL SCHOOL - PERIO
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2015-02-09
Deactivation Date:2015-01-20
Deactivation Code:
Reactivation Date:2015-02-09
Provider Licenses
StateLicense IDTaxonomies
ZZ1602PADOVA122300000X
MADC123951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist