Provider Demographics
NPI:1225531957
Name:TADDESSEE, ISAAC SAMUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:SAMUEL
Last Name:TADDESSEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 BINGLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-4838
Mailing Address - Country:US
Mailing Address - Phone:571-228-3417
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD STE 650
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3105
Practice Address - Country:US
Practice Address - Phone:301-839-1330
Practice Address - Fax:301-839-6273
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170431223G0001X
VA04014166861223G0001X
DCDEN10020391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice