Provider Demographics
NPI:1346819265
Name:COVARRUBIAS, ISAAC (DDS)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:COVARRUBIAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ISAAC
Other - Middle Name:
Other - Last Name:COVARRUBIAS MELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14424 W 84TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4175
Mailing Address - Country:US
Mailing Address - Phone:402-201-3484
Mailing Address - Fax:
Practice Address - Street 1:16971 W 94TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1939
Practice Address - Country:US
Practice Address - Phone:402-559-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77381223G0001X
KS622431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice