Provider Demographics
NPI:1205152030
Name:ISAKOV, ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:ISAKOV
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 1:10 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1410
Mailing Address - Country:US
Mailing Address - Phone:917-662-1070
Mailing Address - Fax:
Practice Address - Street 1:10 CEDAR SWAMP RD STE 2
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-750-8585
Practice Address - Fax:516-750-8584
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 055548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03368123Medicaid