Provider Demographics
NPI:1841538923
Name:ISIS MASSOUD, DDS
Entity type:Organization
Organization Name:ISIS MASSOUD, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-449-1088
Mailing Address - Street 1:7063 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-5301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7063 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-5301
Practice Address - Country:US
Practice Address - Phone:301-449-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty