Provider Demographics
NPI:1669515557
Name:ISAAC, ALAN HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:HOWARD
Last Name:ISAAC
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 1:8921 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1617
Mailing Address - Country:US
Mailing Address - Phone:708-485-1755
Mailing Address - Fax:
Practice Address - Street 1:8921 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1617
Practice Address - Country:US
Practice Address - Phone:708-485-1755
Practice Address - Fax:798-485-5982
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14074122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist