Provider Demographics
NPI:1669626487
Name:ISAACS, GARY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:ISAACS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-4200
Mailing Address - Country:US
Mailing Address - Phone:302-652-8947
Mailing Address - Fax:
Practice Address - Street 1:830 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-4200
Practice Address - Country:US
Practice Address - Phone:302-652-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG1-0001133OtherSTATE DENTAL LICENSE NUMBER