Provider Demographics
NPI:1881924959
Name:ISING, NICHOLAS S (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:S
Last Name:ISING
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2750
Mailing Address - Country:US
Mailing Address - Phone:270-769-2186
Mailing Address - Fax:270-982-2666
Practice Address - Street 1:1102 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2750
Practice Address - Country:US
Practice Address - Phone:270-769-2186
Practice Address - Fax:270-982-2666
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY88351223G0001X
KY8441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice