Provider Demographics
NPI:1902818016
Name:ISEBRANDS, DAVID CLARENCE (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLARENCE
Last Name:ISEBRANDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:100 2ND ST
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-0430
Mailing Address - Country:US
Mailing Address - Phone:605-384-3603
Mailing Address - Fax:605-384-3604
Practice Address - Street 1:100 2ND ST
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-0430
Practice Address - Country:US
Practice Address - Phone:605-384-3603
Practice Address - Fax:605-384-3604
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist