Provider Demographics
NPI:1760201784
Name:THOMAS G ISON DMD LLC
Entity type:Organization
Organization Name:THOMAS G ISON DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-490-8070
Mailing Address - Street 1:8966 RUFFIAN LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3424
Mailing Address - Country:US
Mailing Address - Phone:812-490-8070
Mailing Address - Fax:812-490-8072
Practice Address - Street 1:8966 RUFFIAN LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3424
Practice Address - Country:US
Practice Address - Phone:812-490-8070
Practice Address - Fax:812-490-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty