Provider Demographics
NPI:1215308598
Name:SOSA, ISIS (DMD)
Entity type:Individual
Prefix:DR
First Name:ISIS
Middle Name:
Last Name:SOSA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19850 NW 78TH PATH
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6631
Mailing Address - Country:US
Mailing Address - Phone:786-246-5452
Mailing Address - Fax:
Practice Address - Street 1:19850 NW 78TH PATH
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6631
Practice Address - Country:US
Practice Address - Phone:786-246-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY90847271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice