Provider Demographics
NPI:1588892368
Name:ISAACSON, JASON W (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:ISAACSON
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 1:2901 PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2434
Mailing Address - Country:US
Mailing Address - Phone:715-609-2461
Mailing Address - Fax:
Practice Address - Street 1:2901 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2434
Practice Address - Country:US
Practice Address - Phone:715-609-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65921223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice