Provider Demographics
NPI:1649288762
Name:ISMAJ, ISRAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ISRAEL
Middle Name:
Last Name:ISMAJ
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 1:4540 KEARNY VILLA RD STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1577
Mailing Address - Country:US
Mailing Address - Phone:858-571-3534
Mailing Address - Fax:858-483-1070
Practice Address - Street 1:4540 KEARNY VILLA RD STE 116
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1577
Practice Address - Country:US
Practice Address - Phone:858-571-3534
Practice Address - Fax:858-483-1070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice