Provider Demographics
NPI:1235270737
Name:ISAACMAN, KENNETH L (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:ISAACMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S WALNUT BEND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7216
Mailing Address - Country:US
Mailing Address - Phone:901-755-4006
Mailing Address - Fax:901-309-0749
Practice Address - Street 1:315 S WALNUT BEND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7216
Practice Address - Country:US
Practice Address - Phone:901-755-4006
Practice Address - Fax:901-309-0749
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS31611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice