Provider Demographics
NPI:1669569844
Name:PIKE, ISAAC S IV (DMD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:S
Last Name:PIKE
Suffix:IV
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ANNESLEY DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1355
Mailing Address - Country:US
Mailing Address - Phone:484-840-2601
Mailing Address - Fax:
Practice Address - Street 1:202 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2908
Practice Address - Country:US
Practice Address - Phone:610-565-3963
Practice Address - Fax:610-565-1967
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029838L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice