Provider Demographics
NPI:1740653146
Name:MORTON, ISSAC DRAKE (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:ISSAC
Middle Name:DRAKE
Last Name:MORTON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:ISAAC
Other - Middle Name:DRAKE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:7777 HENNESSY BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4365
Mailing Address - Country:US
Mailing Address - Phone:225-763-3939
Mailing Address - Fax:225-763-3947
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:MEDICAL PLAZA 1, SUITE 306
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-763-3939
Practice Address - Fax:225-763-3947
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36130204E00000X
NC11335204E00000X
LA345913208600000X
LA7712204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery