Provider Demographics
NPI:1013639533
Name:ISSA, MICHEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:
Last Name:ISSA
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 1:7809 S LAURELGLEN BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-8849
Mailing Address - Country:US
Mailing Address - Phone:858-262-3216
Mailing Address - Fax:
Practice Address - Street 1:4221 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-7205
Practice Address - Country:US
Practice Address - Phone:661-200-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1080281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice