Provider Demographics
NPI:1578359832
Name:EDISON ISHAYA DENTAL
Entity type:Organization
Organization Name:EDISON ISHAYA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-501-0066
Mailing Address - Street 1:20501 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1701
Mailing Address - Country:US
Mailing Address - Phone:847-501-0066
Mailing Address - Fax:
Practice Address - Street 1:20501 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1701
Practice Address - Country:US
Practice Address - Phone:847-501-0066
Practice Address - Fax:209-498-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty