Provider Demographics
NPI:1881733236
Name:ISBRANDT, JOHN MARVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARVIN
Last Name:ISBRANDT
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 1:4N399 SAMUEL LANGHORNE CLEMENS CRSE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6511
Mailing Address - Country:US
Mailing Address - Phone:630-587-8827
Mailing Address - Fax:630-584-8797
Practice Address - Street 1:2210 DEAN ST
Practice Address - Street 2:SUITE O-2
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1066
Practice Address - Country:US
Practice Address - Phone:630-584-8787
Practice Address - Fax:630-584-8797
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice