Provider Demographics
NPI:1831188382
Name:ISON, THOMAS GLENN (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GLENN
Last Name:ISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8966 RUFFIAN LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3424
Mailing Address - Country:US
Mailing Address - Phone:812-490-8070
Mailing Address - Fax:812-490-8072
Practice Address - Street 1:8966 RUFFIAN LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3424
Practice Address - Country:US
Practice Address - Phone:812-490-8070
Practice Address - Fax:812-490-8072
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010534A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry