Provider Demographics
NPI:1730303421
Name:ISAACSON, BRIAN EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:ISAACSON
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 1:4565 CEDAR HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8707
Mailing Address - Country:US
Mailing Address - Phone:801-756-9154
Mailing Address - Fax:801-756-9199
Practice Address - Street 1:4565 CEDAR HILLS DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8707
Practice Address - Country:US
Practice Address - Phone:801-756-9154
Practice Address - Fax:801-756-9199
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5322069-09221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice