Provider Demographics
NPI:1780485573
Name:MICHAEL ISSA DDS, INC
Entity type:Organization
Organization Name:MICHAEL ISSA DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-262-3216
Mailing Address - Street 1:2528 S BROADWAY STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7879
Mailing Address - Country:US
Mailing Address - Phone:805-925-2628
Mailing Address - Fax:805-925-2980
Practice Address - Street 1:2528 S BROADWAY STE C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7879
Practice Address - Country:US
Practice Address - Phone:805-925-2628
Practice Address - Fax:805-925-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental