Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7545 | NE |
NPI | 1528626892 |
---|---|
Provider Name | Dr. Jonathan David Isaacson |
First Address | Lincoln, NE 68516-3621 |
Second Address | Lincoln, NE 68516-3621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2019 |
Last Update Date | 03/06/2019 |