Provider Demographics
NPI:1194990911
Name:DAVID E. ISON, DMD, PSC
Entity type:Organization
Organization Name:DAVID E. ISON, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-823-1811
Mailing Address - Street 1:111 HUMES RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097-9444
Mailing Address - Country:US
Mailing Address - Phone:859-823-1811
Mailing Address - Fax:859-823-1855
Practice Address - Street 1:111 HUMES RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-9444
Practice Address - Country:US
Practice Address - Phone:859-823-1811
Practice Address - Fax:859-823-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45002672OtherEPSDT