Provider Demographics
NPI:1932255684
Name:MENASHA, ISAAC (DDS)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:MENASHA
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 1:1726 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3449
Mailing Address - Country:US
Mailing Address - Phone:732-985-7666
Mailing Address - Fax:732-985-6841
Practice Address - Street 1:1726 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3449
Practice Address - Country:US
Practice Address - Phone:732-985-7666
Practice Address - Fax:732-985-6841
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02183900122300000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental