Provider Demographics
NPI:1740653146
Name:MORTON, ISSAC DRAKE (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:ISSAC
Middle Name:DRAKE
Last Name:MORTON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:ISAAC
Other - Middle Name:DRAKE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:1100 FLORIDA AVE # 18
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2715
Mailing Address - Country:US
Mailing Address - Phone:504-941-8211
Mailing Address - Fax:
Practice Address - Street 1:1100 FLORIDA AVE # 18
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2715
Practice Address - Country:US
Practice Address - Phone:504-941-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11335204E00000X
LAS-1187204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery