Provider Demographics
NPI:1750486833
Name:ISAACS, MARY ROSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ROSE
Last Name:ISAACS
Suffix:
Gender:F
Credentials:DMD
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Other - First Name:
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Mailing Address - Street 1:5965 RED BUG LAKE RD
Mailing Address - Street 2:SUITE 233
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5080
Mailing Address - Country:US
Mailing Address - Phone:407-696-5210
Mailing Address - Fax:407-696-6488
Practice Address - Street 1:5965 RED BUG LAKE RD
Practice Address - Street 2:SUITE 233
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5080
Practice Address - Country:US
Practice Address - Phone:407-696-5210
Practice Address - Fax:407-696-6488
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN 130971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
642592OtherUNITED CONCORDIA
69975OtherBLUE CROSS/BLUE SHIELD