Provider Demographics
NPI:1811092893
Name:MARY R. ISAACS, D.M.D., P.A.
Entity type:Organization
Organization Name:MARY R. ISAACS, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ISAACS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-696-5210
Mailing Address - Street 1:5965 RED BUG LAKE RD
Mailing Address - Street 2:SUITE 233
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5080
Mailing Address - Country:US
Mailing Address - Phone:407-696-5210
Mailing Address - Fax:407-696-6488
Practice Address - Street 1:5965 RED BUG LAKE RD
Practice Address - Street 2:SUITE 233
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5080
Practice Address - Country:US
Practice Address - Phone:407-696-5210
Practice Address - Fax:407-696-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 130971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
69975OtherBLUE CROSS/BLUE SHIELD
642592OtherUNITED CONCORDIA