Provider Demographics
NPI:1326604489
Name:YOUSSEF- ISAAC, MARY (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:YOUSSEF- ISAAC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 WILLOW CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3235
Mailing Address - Country:US
Mailing Address - Phone:651-230-9142
Mailing Address - Fax:
Practice Address - Street 1:550 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1014
Practice Address - Country:US
Practice Address - Phone:610-833-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND141771223G0001X
PADS0426331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice