Provider Demographics
NPI:1700018702
Name:DR. ISAAC ADEDARA
Entity Type:Organization
Organization Name:DR. ISAAC ADEDARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEDARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-588-6060
Mailing Address - Street 1:8605 CAMERON ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3710
Mailing Address - Country:US
Mailing Address - Phone:301-588-6060
Mailing Address - Fax:301-588-6088
Practice Address - Street 1:8605 CAMERON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3710
Practice Address - Country:US
Practice Address - Phone:301-588-6060
Practice Address - Fax:301-588-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty