Provider Demographics
NPI:1316117369
Name:DAVISON, ISAAC E (DDS)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:E
Last Name:DAVISON
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 1:1226 S WASHINGTON ST
Mailing Address - Street 2:PO BOX 330
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-3853
Mailing Address - Country:US
Mailing Address - Phone:618-542-8832
Mailing Address - Fax:618-542-9255
Practice Address - Street 1:1226 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-3853
Practice Address - Country:US
Practice Address - Phone:618-542-8832
Practice Address - Fax:618-542-9255
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice