Provider Demographics
NPI:1861971335
Name:ANDERSON, ISABELLA (DMD)
Entity type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PARKLANDS DR UNIT 1217
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5182
Mailing Address - Country:US
Mailing Address - Phone:706-399-3633
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL ACTIVITY, HOSPITAL DENTAL CLINIC
Practice Address - Street 2:BLDG 38801 ACADEMIC, STE B&C
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23759122300000X, 1223S0112X
FL23759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist