Provider Demographics
NPI:1861513376
Name:ISSA, AEJAAZ (DMD)
Entity type:Individual
Prefix:DR
First Name:AEJAAZ
Middle Name:
Last Name:ISSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-2314
Mailing Address - Country:US
Mailing Address - Phone:610-965-6898
Mailing Address - Fax:610-965-6419
Practice Address - Street 1:550 HARRISON ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2314
Practice Address - Country:US
Practice Address - Phone:610-965-6898
Practice Address - Fax:610-481-0166
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics