Provider Demographics
NPI:1649330317
Name:ISHAK, ADEL YACOUB (DDS)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:YACOUB
Last Name:ISHAK
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 1:336 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1101
Mailing Address - Country:US
Mailing Address - Phone:215-476-9518
Mailing Address - Fax:215-476-3522
Practice Address - Street 1:336 N 63RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1101
Practice Address - Country:US
Practice Address - Phone:215-476-9518
Practice Address - Fax:215-476-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020233L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist