Provider Demographics
NPI:1851500920
Name:ISAZA, ANGELICA M (DMD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:ISAZA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CLIFTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1426
Mailing Address - Country:US
Mailing Address - Phone:201-662-8137
Mailing Address - Fax:201-295-8475
Practice Address - Street 1:8407 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4338
Practice Address - Country:US
Practice Address - Phone:201-868-2747
Practice Address - Fax:201-295-8475
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02308400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist